Science.gov

Sample records for anterior wall myocardial

  1. Relationship of ST-segment elevation to eventual QRS loss in acute anterior wall myocardial infarction.

    PubMed

    Bell, A J; Briggs, C M; Nichols, P; Kilpatrick, D

    1993-07-01

    The position of electrocardiographic ST-segment elevation in acute myocardial infarction (MI) is related to the region of infarction, but the relationship between the initial ST-segment elevation and the eventual loss of QRS voltage remains uncertain. The authors examined body surface map data in 76 patients with acute anterior wall MI to clarify this relationship. The patients had no evidence of previous MI, no subsequent MI, and did not receive thrombolytic therapy or other acute interventions. Maps were recorded on admission to the hospital, every 24 hours during the hospital stay, and again at follow-up examinations 6-48 months after the index MI. The region of ST-segment elevation on the initial body surface map was compared to the region of developed voltage loss in the QRS complex as measured by the integral 0-30, 0-40, 0-80, and 30-80 ms body surface maps subsequently recorded 24 hours, 48 hours, and over 6 months after the initial body surface map. There was a relationship between the position of the ST-segment elevation and the loss of the QRS segment voltages, which was pronounced early after acute MI and diminished months after the MI. The region of ST-segment elevation in the initial body surface map predicts the QRS loss. In the integral QRS0-30 map versus the initial ST-segment map the mean correlation coefficient was -0.54 +/- 0.33 with a median value of -0.67. The integral QRS0-40 map and ST-segment map had a mean correlation coefficient of 0.60 +/- 0.29 and median of 0.66. The mean correlation coefficient is less for the integral QRS0-80 map and nonexistent in the integral QRS30-80 map. This method may be useful for monitoring acute interventions in acute MI. PMID:8409812

  2. Regional myocardial function after intracoronary bone marrow cell injection in reperfused anterior wall infarction - a cardiovascular magnetic resonance tagging study

    PubMed Central

    2011-01-01

    Background Trials have brought diverse results of bone marrow stem cell treatment in necrotic myocardium. This substudy from the Autologous Stem Cell Transplantation in Acute Myocardial Infarction trial (ASTAMI) explored global and regional myocardial function after intracoronary injection of autologous mononuclear bone marrow cells (mBMC) in acute anterior wall myocardial infarction treated with percutaneous coronary intervention. Methods Cardiovascular magnetic resonance (CMR) tagging was performed 2-3 weeks and 6 months after revascularization in 15 patients treated with intracoronary stem cell injection (mBMC group) and in 13 controls without sham injection. Global and regional left ventricular (LV) strain and LV twist were correlated to cine CMR and late gadolinium enhancement (LGE). Results In the control group myocardial function as measured by strain improved for the global LV (6 months: -13.1 ± 2.4 versus 2-3 weeks: -11.9 ± 3.4%, p = 0.014) and for the infarct zone (-11.8 ± 3.0 versus -9.3 ± 4.1%, p = 0.001), and significantly more than in the mBMC group (inter-group p = 0.027 for global strain, respectively p = 0.009 for infarct zone strain). LV infarct mass decreased (35.7 ± 20.4 versus 45.7 ± 29.5 g, p = 0.024), also significantly more pronounced than the mBMC group (inter-group p = 0.034). LV twist was initially low and remained unchanged irrespective of therapy. Conclusions LGE and strain findings quite similarly demonstrate subtle differences between the mBMC and control groups. Intracoronary injection of autologous mBMC did not strengthen regional or global myocardial function in this substudy. Trial registration ClinicalTrials.gov: NCT00199823 PMID:21414223

  3. Dual antiplatelet compared to triple antithrombotic therapy in anterior wall acute myocardial infarction complicated by depressed left ventricular ejection fraction

    PubMed Central

    Oyetayo, Ola O.; Slicker, Kipp; De La Rosa, Lisa; Lane, Wesley; Langsjoen, Dane; Patel, Chhaya; Brough, Kevin; Chiles, Christopher

    2015-01-01

    Current guidelines recommend triple antithrombotic therapy (TT) consisting of warfarin, aspirin, and a P2Y12 inhibitor following an anterior ST elevation myocardial infarction (STEMI) complicated by extensive wall motion abnormalities. This recommendation, however, is based on data collected before percutaneous coronary intervention (PCI) became the standard of care for the treatment of STEMI. We designed a retrospective study of patients who received PCI for anterior STEMI over an 8-year period to compare rates of thromboembolic and bleeding events between patients receiving dual antiplatelet therapy (DAPT) and those receiving TT, including warfarin. Patients were included if the predischarge echocardiogram showed extensive wall motion abnormality and an ejection fraction ≤35%. Patients with known left ventricular thrombus were excluded. A total of 124 patients met the criteria, with 80 patients in the DAPT group and 44 in the TT group. The median age was 58 years in the TT group and 64 years in the DAPT group (P < 0.04), with an average ejection fraction of 31%. Thromboembolic events occurred in 4 patients (5%) in the DAPT group compared with 3 patients (6.8%) in the TT group (P = 0.70). Bleeding occurred in 2 patients in the DAPT group and 4 patients in the TT group (2.5% in DAPT vs. 9.1% in TT group, P = 0.18). No differences in rates of clinical embolism or left ventricular thrombus were found. Our data support recent findings that warfarin may not be indicated for patients following PCI for anterior STEMI, even when significant wall motion abnormalities and reduced ejection fraction ≤35% are present. PMID:26424937

  4. Rituximab-vincristine chemotherapy-induced acute anterior wall myocardial infarction with cardiogenic shock.

    PubMed

    Roy, Ambuj; Khanna, Naveen; Senguttuvan, Nagendra Boopathy

    2014-02-01

    We present a case of an elderly man with coronary artery disease who was diagnosed with non-Hodgkin lymphoma. Soon after the administration of chemotherapy, which included rituximab and vincristine, he developed acute myocardial infarction with cardiogenic shock. The condition was managed successfully with primary percutaneous coronary intervention. We briefly discuss the possible pathogenic mechanisms of chemotherapy-induced ischemic syndrome and the management of chemotherapy in patients with high cardiovascular risk. PMID:24512409

  5. Effect of low dose acetylsalicylic acid on the frequency and hematologic activity of left ventricular thrombus in anterior wall acute myocardial infarction

    SciTech Connect

    Kuepper, A.J.V.; Verheugt, F.W.; Peels, C.H.; Galema, T.W.; den Hollander, W.; Roos, J.P.

    1989-04-15

    In this prospective, randomized, placebo-controlled trial the effect of 100 mg acetylsalicylic acid (ASA) once daily on the incidence, hematologic activity and embolic potential of left ventricular (LV) thrombosis was studied in 100 consecutive patients with a first anterior wall acute myocardial infarction (AMI). Patients were randomized to ASA or placebo less than 12 hours after onset of symptoms. Heparin, 5,000 IU subcutaneously twice daily, was given to all patients during immobilization. Echocardiography was performed less than 24 hours, 48 to 72 hours and 1, 2, and 12 weeks after AMI. LV thrombosis was detected by echocardiography in 30 (33%) of the 92 evaluable patients (15 patients given ASA and 15 given placebo). Indium-111 platelet scintigraphy was done in 17 of the 22 patients with an LV thrombus at the second week echocardiogram. Among 7 ASA-treated patients, 4 had positive images; among 10 placebo patients, 5 had positive images. LV thrombus resolution was noted in 3 of 9 patients with a positive scan and in 5 of 8 patients with a negative platelet scan. In 7 of 10 ASA-treated patients and 5 of 12 placebo-treated patients thrombus resolution was observed (difference not significant). Systemic embolism occurred in 2 patients, both given ASA, during the first week after AMI. Thus, low dose ASA has no effect on the incidence, hematologic activity and embolic potential of LV thrombosis in anterior wall AMI.

  6. Six-month angiographic study of immediate autologous bone marrow mononuclear cell implantation on acute anterior wall myocardial infarction using a mini-pig model.

    PubMed

    Sheu, Jiunn-Jye; Yuen, Chun-Man; Sun, Cheuk-Kwan; Chang, Li-Teh; Yen, Chia-Hung; Chiang, Chiang-Hua; Ko, Sheung-Fat; Pei, Sung-Nan; Chua, Sarah; Bhasin, Anuj; Wu, Chiung-Jen; Yip, Hon-Kan

    2009-03-01

    This study investigated six-month angiographic results of autologous bone marrow mononuclear cell (BMMNC) transplantation immediately following acute myocardial infarction (AMI) in a mini-pig model.AMI was induced by left anterior descending artery ligation. Twenty-four mini-pigs were equally divided into group 1 [AMI plus saline injection in infarcted area (IA)], group 2 (AMI plus BMMNC transplantation into non-IA), group 3 (AMI plus BMMNC implantation into IA), and group 4 (sham control). One-week cultured BMMNCs (3.0 x 10(7)) were immediately transplanted following AMI induction. Angiographic studies over 6 months demonstrated that mitral regurgitation (MR) was lower in groups 3 and 4 than in groups 1 and 2 (all P < 0.01). Wall motion scores and left ventricular ejection fraction (LVEF) were higher in groups 3 and 4 than in groups 1 and 2 (all P < 0.05). Collateral circulation was higher in group 3 than in groups 1 and 2 ( P < 0.01). The wall thickness of the IA was higher, whereas the heart weight was lower in group 3 than in groups 1 and 2 (all P < 0.01).Immediate autologous BMMNC transplantation into IA is superior to saline-treated only or BMMNC transplantation into non-IA following AMI for reducing MR and improving LVEF. PMID:19367032

  7. Granulocyte colony-stimulating factor therapy for stem cell mobilization following anterior wall myocardial infarction: the CAPITAL STEM MI randomized trial

    PubMed Central

    Hibbert, Benjamin; Hayley, Bradley; Beanlands, Robert S.; Le May, Michel; Davies, Richard; So, Derek; Marquis, Jean-François; Labinaz, Marino; Froeschl, Michael; O’Brien, Edward R.; Burwash, Ian G.; Wells, George A.; Pourdjabbar, Ali; Simard, Trevor; Atkins, Harold; Glover, Christopher

    2014-01-01

    Background: Small studies have yielded divergent results for administration of granulocyte colony-stimulating factor (G-CSF) after acute myocardial infarction. Adequately powered studies involving patients with at least moderate left ventricular dysfunction are lacking. Methods: Patients with left ventricular ejection fraction less than 45% after anterior-wall myocardial infarction were treated with G-CSF (10 μg/kg daily for 4 days) or placebo. After initial randomization of 86 patients, 41 in the placebo group and 39 in the G-CSF group completed 6-month follow-up and underwent measurement of left ventricular ejection fraction by radionuclide angiography. Results: Baseline and 6-week mean ejection fraction was similar for the G-CSF and placebo groups: 34.8% (95% confidence interval [CI] 32.6%–37.0%) v. 36.4% (95% CI 33.5%–39.2%) at baseline and 39.8% (95% CI 36.2%–43.4%) v. 43.1% (95% CI 39.2%–47.0%) at 6 weeks. However, G-CSF therapy was associated with a lower ejection fraction at 6 months relative to placebo (40.8% [95% CI 37.4%–44.2%] v. 46.0% [95% CI 42.7%–44.3%]). Both groups had improved left ventricular function, but change in left ventricular ejection fraction was lower in patients treated with G-CSF than in those who received placebo (5.7 [95% CI 3.4–8.1] percentage points v. 9.2 [95% CI 6.3–12.1] percentage points). One or more of a composite of several major adverse cardiac events occurred in 8 patients (19%) within each group, with similar rates of target-vessel revascularization. Interpretation: In patients with moderate left ventricular dysfunction following anterior-wall infarction, G-CSF therapy was associated with a lower 6-month left ventricular ejection fraction but no increased risk of major adverse cardiac events. Future studies of G-CSF in patients with left ventricular dysfunction should be monitored closely for safety. Trial registration: ClinicalTrials.gov, no. NCT00394498 PMID:24934893

  8. Early results of a novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn

    PubMed Central

    2014-01-01

    Background The aim of this study was to describe the results of a 1-year patient follow-up after anterior vaginal wall darn, a novel technique for the repair of anterior vaginal wall prolapse. Methods Fifty-five patients with anterior vaginal wall prolapse underwent anterior vaginal wall darn. The anterior vaginal wall was detached using sharp and blunt dissection via an incision beginning 1 cm proximal to the external meatus and extending to the vaginal apex. The space between the tissues that attach the lateral vaginal walls to the arcus tendineus fasciae pelvis was then darned. Cough Stress Test, Pelvic Organ Prolapse Quantification, seven-item Incontinence Impact Questionnaire, and six-item Urogenital Distress Inventory scores were performed 1-year postoperatively to evaluate recovery. Results One-year postoperatively, all patients were satisfied with the results of the procedure. No patient had vaginal mucosal erosion or any other complication. Conclusions One-year postoperative findings for patients in this series indicate that patients with stage II–III anterior vaginal wall prolapse were successfully treated with the anterior vaginal wall darn technique. PMID:24973955

  9. 131Cs myocardial scintigraphy. Application to assessment of anterior myocardial infarction.

    PubMed Central

    Burguet, W; Merchie, G; Kulbertus, H

    1975-01-01

    Earlier studies have indicated that caesium-131 is a good myocardial scanning agent for the demonstration of anterior infarcts. One hundred and ten patients with documented anterior myocardial infarction were studied by 131Cs myocardial scintigraphy. An anterior area of decreased uptake of caesium was noted in all but 3 subjects whose necrotic zone was likely to be of small dimensions. In 20 cases, the scintigram showed a definite, sometimes very large, cold area whereas the electrocardiogram failed to display any diagnostic feature of myocardial necrosis. In most of the latter instances, the electrocardiographic diagnosis was obscured by the presence of intraventricular conduction disturbances. In order to visualize the intracardiac cavities, the 131Cs investigation was usually completed by a 113mIn scintigram, which allowed recognition of a parietal aneurysm in 12 of the 18 patients with extensive anterior lesions. In each case, an index of necrosis was computed from planimetric measurements of the infarcted area as compared to the total left ventricular surfact in both the anteroposterior and left anterior oblique projections. This index was shown to correlate with the incidence of major complications developing after the acute episode of coronary occlusion. The sensitivity, specificity, and accuracy of the method are briefly discussed. It is felt that myocardial scintigraphy represents a sound approach to the semiquantitative assessment of anterior myocardial infarction; the clinical usefulness of the technique seems sufficiently demonstrated to prompt further research in this field. Images PMID:1191417

  10. Supine versus upright anterior images: comparison in T1-201 myocardial scintigraphy

    SciTech Connect

    Jacobson, A.F.; Parker, J.A.; Royal, H.D.; Silverman, K.J.; Gervino, E.V.; Kolodny, G.M.

    1987-06-01

    In patients undergoing exercise thallium-201 myocardial scintigraphy, activity in the inferior wall on anterior images may appear diminished when the standard supine view is used, but normal when the view is acquired with the patient upright. To determine the clinical significance of this observation, the distribution of thallium-201 activity was semiquantitatively assessed in supine and upright anterior images obtained immediately after exercise in 93 patients (65 men, 28 women). The presence of inferior wall and coronary artery disease was established with coronary angiography or from documentation of previous myocardial infarction. Supine and upright images were compared with use of receiver operating characteristic curves. In male patients diagnostic accuracy for identification of both inferior wall and coronary artery disease was improved through the use of the upright anterior image. In women, there was no significant difference in reader performance with upright and supine images. Upright anterior images should be routinely obtained in men in order to reduce the frequency of false-positive identification of inferior wall defects.

  11. Subclinical Myocardial Impairment Occurred in Septal and Anterior LV Wall Segments After Anthracycline-Embedded Chemotherapy and did not Worsen During Adjuvant Trastuzumab Treatment in Breast Cancer Patients.

    PubMed

    Lange, Stefan Andreas; Jung, Jens; Jaeck, Almut; Hitschold, Thomas; Ebner, Bernd

    2016-04-01

    In a previous study of breast cancer patients, we found changes in cardiac function and size during the early stages of adjuvant trastuzumab (Herceptin(®)) therapy. Here we present a subgroup analysis of this patient cohort. This subgroup received a anthracycline-embedded chemotherapy followed by at least 3 months up to 6 months of adjuvant Herceptin(®) therapy. Twenty-seven female breast cancer patients with Her-2/-neu overexpression were studied using conventional echocardiography and 2D speckle tracking. These methods were done before anthracycline-embedded chemotherapy, before adjuvant trastuzumab therapy, and both 3 and 6 months after the start of the therapy (T3, T6). The LV-EF (Simpson biplane) decreased significantly from before the chemotherapy to after the chemotherapy and further decreased after 3 months of trastuzumab therapy (66.2 ± 1.5 vs. 58.7 ± 1.2 vs. 55.6 ± 1.3 vs. 55.9 ± 1.5 %; p < 0.05). The stroke volume index remained constant after chemotherapy (22.0 ± 0.8 vs. 22.6 ± 1.3 ml/m(2); p = 0.9), but increased significantly during trastuzumab therapy (26.7 ± 1.1 and 27.3 ± 1.0 ml/m(2); p < 0.01). Global longitudinal strain exclusively decreased during chemotherapy (-21.0 ± 0.5 vs. -18.9 ± 0.5 %, p < 0.001). Regional longitudinal strain decreased significantly after chemotherapy in septal, anteroseptal, anterolateral, and apex segments. Mitral valve regurgitation increased during the whole treatment, but especially during trastuzumab. Right ventricular function decreased exclusively during chemotherapy. Anthracycline-embedded chemotherapy in patients with breast cancer led to a decrease in LV function, especially of the septal and anterior segments, and did not worsen during adjuvant trastuzumab treatment. PMID:26022230

  12. Usefulness of the Left Anterior Descending Coronary Artery Wrapping Around the Left Ventricular Apex to Predict Adverse Clinical Outcomes in Patients With Anterior Wall ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial).

    PubMed

    Kobayashi, Nobuaki; Maehara, Akiko; Brener, Sorin J; Généreux, Philippe; Witzenbichler, Bernhard; Guagliumi, Giulio; Peruga, Jan Z; Mehran, Roxana; Mintz, Gary S; Stone, Gregg W

    2015-12-01

    The association between anatomic features of the left anterior descending artery (LAD) and outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. We sought to clarify the impact of an LAD coronary artery wrapping around the left ventricular (LV) apex on clinical outcomes in patients with anterior STEMI. Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction enrolled patients with STEMI presenting <12 hours after symptom onset who underwent primary percutaneous coronary intervention. Patients with a culprit lesion in the LAD were categorized as (1) LAD wrapping around the LV apex (wrap-around LAD, n = 871) versus (2) LAD not wrapping around the LV apex (non-wrap-around LAD, n = 224). Killip class ≥II, dysrhythmia, and LV mural thrombi were more frequently observed in the wrap-around LAD group; LV ejection fraction was worse in the wrap-around LAD group (54.5% vs 58.7%, p = 0.006). At 3 years of follow-up, major adverse cardiac events (death, stroke, or stent thrombosis, 12.7% vs 5.4%, p = 0.002), death (6.6% vs 3.2%, p = 0.052), stroke (1.9% vs 0.5%, p = 0.12), stent thrombosis (5.6% vs 2.3%, p = 0.047), and severe heart failure (4.5% vs 1.4%, p = 0.03) were more common in patients with a wrap-around LAD versus those with a non-wrap-around LAD. Multivariate analysis indicated that a wrap-around LAD independently and significantly predicted major adverse cardiac events (hazard ratio 2.18, p = 0.02) and severe heart failure (odds ratio 3.31, p = 0.049) in patients with an anterior STEMI. In conclusion, a wrap-around LAD predicted adverse clinical outcomes at 3 years in patients with anterior STEMI who underwent primary percutaneous coronary intervention. PMID:26433272

  13. [Painless anterior acute myocardial infarction in a transplanted heart].

    PubMed

    Poyet, R; Capilla, E; Tortat, A V; Brocq, F X; Pons, F; Kerebel, S; Jego, C; Cellarier, G R

    2015-11-01

    Cardiac allograft vasculopathy is the major determinant of long-term survival in patients after heart transplantation. Clinical presentations are congestive heart failure, ventricular arrhythmias and sudden cardiac death. Acute coronary syndrome is a rare presentation of cardiac allograft vasculopathy due to myocardial denervation. We present the case of a 31-year-old patient, who had undergone heart transplantation 6 months earlier and who developed a painless anterior myocardial infarction revealed by syncope. He was successfully treated by percutaneous coronary intervention with drug eluting stent implantation. PMID:26472502

  14. Significance of U wave polarities in previous anterior myocardial infarction

    SciTech Connect

    Kanemoto, N.; Imaoka, C.; Suzuki, Y. )

    1991-04-01

    The significance of the polarity of U waves in left precordial leads was evaluated in relation to myocardial perfusion (T1 201 myocardial scintigraphy) and left ventricular function (99m Tc radionuclide ventriculography) in 63 patients with clinical and electrocardiographic evidence of a previous anterior myocardial infarction. Patients were divided into three groups according to the polarity of the U waves: positive U waves, flat U waves, and negative U waves. Twelve matched patients served as normal controls. The following parameters were analyzed: (1) total number of abnormal Q waves; (2) total myocardial perfusion index and regional myocardial perfusion index; (3) global ejection fraction; (4) regional ejection fraction; and (5) number of diseased coronary arteries. The total myocardial perfusion index values were 43.9 {plus minus} 1.0 in controls, 40.8 {plus minus} 3.4 in the positive U wave group, 33.4 {plus minus} 3.5 in the flat U wave group, and 30.3 {plus minus} 4.4 in the patients with negative U waves. Global ejection fractions in these groups were, respectively, 63.9 {plus minus} 8.6%, 65.0 {plus minus} 11.8%, 53.6 {plus minus} 8.1%, and 36.5 {plus minus} 13.6%. The sensitivity of negative U waves suggesting a global ejection fraction of less than 45% was 91.6%, and the specificity was 82.1%. Therefore the size of myocardial infarction increased and left ventricular function decreased, in order, from patients with positive U waves, to those with flat U waves, to those with negative U waves, with statistically significant differences.

  15. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

    SciTech Connect

    Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

    1982-09-01

    To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms.

  16. Break into left anterior descending coronary artery suggest myocardial bridging.

    PubMed

    Siniscalchi, Carmine; Basaglia, Manuela; Gaibazzi, Nicola

    2016-01-01

    A 67 year-old woman presented with stable effort angina. A resting electrocardiogram was inconclusive. High-dose dipyridamole contrast-echocardiography shows normal left ventricular wall motion after 0.84mg/kg/6min dipyridamole. At rest a turbolent flow demonstrable by color aliasing, appeared in the territory of the left anterior descending coronary artery (LAD) during the diastolic phase. PMID:27163904

  17. Prognostic significance of resting anterior thallium-201 defects in patients with inferior myocardial infarction

    SciTech Connect

    Gibson, R.S.; Taylor, G.J.; Watson, D.D.; Berger, B.C.; Crampton, R.S.; Martin, R.P.; Beller, G.A.

    1980-11-01

    To determine whether Tl-201 scintigraphy performed at rest during the late hospital phase of inferior myocardial infarction can predict subsequent coronary events, 25 patients with historical, enzymatic, and electrocardiographic criteria of transmural inferior infarction underwent serial imaging with computer quantification 7 to 35 days after admission. All 25 patients had inferior defects, and 13 (52%) also had anterior defects implying stenosis of the left anterior descending coronary artery. The patients were divided into those with inferior and anterior perfusion defects (Group 1) and those with inferior defects alone (Group 2). In Group 1, three patients had persistent defects in the anterior wall and ten had initial defects with redistribution. New or recurrent coronary events - which included new onset or progression of angina pectoris, sudden death, reinfarction, and congestive heart failure - were recorded over an average 7.2 months of followup (range 3 to 9 mo) for all patients. Ten of 13 (77%) patients in Group 1 had 17 coronary events and four of 12 (33%) patients in Group 2 had six coronary events (p < 0.02). Nine patients in Group 1 and three in Group 2 developed angina (p < 0.03). The apparently increased prevalence in Group 1 of sudden death (8% against 0%), reinfarction (8% against 0%), and congestive heart failure (46% against 25%) was not statistically significant. Thus resting T1-201 scintigraphy with computer quantification is a highly sensitive method to detect inferior myocardial infarction even in the late hospital phase. Moreover, it appears to identify those patients with inferior infarction at high risk for subsequent coronary events, presumably due to stenosis of the left anterior descending coronary artery.

  18. Anterior ST segment depression in acute inferior myocardial infarction as a marker of greater inferior, apical, and posterolateral damage

    SciTech Connect

    Ruddy, T.D.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Newell, J.B.; McKusick, K.A.; Boucher, C.A.; Strauss, H.W.

    1986-12-01

    The clinical significance of anterior precordial ST segment depression during acute inferior myocardial infarction was evaluated in 67 consecutive patients early after onset of symptoms with gated blood pool scans, thallium-201 perfusion images, and 12-lead ECGs. Patients with anterior ST depression (n = 33) had depressed mean values for left ventricular ejection fraction (54 +/- 2% (mean +/- S.E.M.) vs 59 +/- 2%; p = 0.02), cardiac index (3.1 +/- 0.2 vs 3.6 +/- 0.2 L/m2; p = 0.03), and ratio of systolic blood pressure to end-systolic volume (2.0 +/- 0.1 vs 2.5 +/- 0.3 mm Hg/ml; p = 0.04) compared to patients with no anterior ST depression (n = 34). Patients with anterior ST depression had (1) lower mean wall motion values for the inferior, apical, and inferior posterolateral segments (p less than 0.05) and (2) greater reductions in thallium-201 uptake in the inferior and posterolateral regions (p less than 0.05). However, anterior and septal (1) wall motion and (2) thallium-201 uptake were similar in patients with and without ST depression. Thus, anterior precordial ST segment depression in patients with acute inferior wall myocardial infarction represents more than a reciprocal electrical phenomenon. It identifies patients with more severe wall motion impairment and greater hypoperfusion of the inferior and adjacent segments. The poorer global left ventricular function in these patients is a result of more extensive inferior infarction and not of remote septal or anterior injury.

  19. The surgical anatomy of rectocele and anterior rectal wall intussusception.

    PubMed

    Abendstein, B; Petros, P E P; Richardson, P A; Goeschen, K; Dodero, D

    2008-05-01

    The aim of the study was to analyse the dynamic anatomical supports of the posterior vaginal wall from the perspective of rectocele and rectal intussusception repair. Two groups of patients were studied. Group 1 (n = 24) with genuine stress incontinence but no major vault prolapse had vagino/proctomyograms and transperineal ultrasound examinations. Group 2 with vaginal vault prolapse, clinical rectoceles and obstructive defecation symptoms (n = 19 had single-contrast defecating proctography before and after posterior-sling surgery. The posterior vaginal wall is suspended between perineal body, which underlies half its length, and uterosacral ligaments, which also support the anterior wall of rectum. Muscle forces stretch the vagina and rectum against the perineal body and uterosacral ligaments, creating shape and strength, like a suspension bridge. Postoperative proctogram studies indicated that anterior rectal wall intussusception has the same etiology as rectocele, deficient recto-vaginal ligamentous support. Repair to uterosacral ligaments and perineal body should be considered with large rectoceles, anterior rectal wall intussusception and obstructive defecation disorders. PMID:18074069

  20. Prone versus supine thallium myocardial SPECT: A method to decrease artifactual inferior wall defects

    SciTech Connect

    Segall, G.M.; Davis, M.J.

    1989-04-01

    Artifactual inferior wall defects as a result of diaphragmatic attenuation of activity are a frequent source of error in thallium myocardial single photon emission computed tomography (SPECT) studies. Thirty-four patients and 11 clinically normal volunteers were studied prospectively to see if specificity of inferior wall defects for right coronary artery disease could be improved by scanning patients prone versus supine. All individuals were scanned both prone and supine, in random order, following symptom limited treadmill exercise. Images were acquired at 3 degrees steps, 25 sec per frame, in a 180 degrees elliptical orbit always beginning in the 45 degrees right anterior oblique position relative to the patient. Polar maps generated from the short axis slices were used to calculate the average regional activity. The prone studies showed consistently higher inferior wall activity compared to the supine studies on both the exercise (182 +/- 22 vs. 160 +/- 23, p less than or equal to 0.001) and 4-hr delay studies (183 +/- 20 vs. 175 +/- 21, p less than or equal to 0.001). Prone imaging resulted in a significantly higher specificity for RCA disease compared to supine imaging (90% vs. 66%, p less than 0.05) with an improvement in accuracy from 71% to 82%. Sensitivity, specificity, and accuracy for left anterior descending and left circumflex artery disease were not significantly affected by patient position during imaging. All patients having SPECT thallium myocardial perfusion studies should be imaged prone to minimize artifactual inferior wall defects and improve accuracy.

  1. Prone decubitus: A solution to inferior wall attenuation in thallium-201 myocardial tomography

    SciTech Connect

    Esquerre, J.P.; Coca, F.J.; Martinez, S.J.; Guiraud, R.F.

    1989-03-01

    We propose an efficient method to suppress inferior wall attenuation in /sup 201/TI 180 degrees myocardial tomography. We systematically performed redistribution studies in both supine and prone decubitus, assuming that the latter should result in shifting with respect to each other's cardiac structures and diaphragm as well as subphrenic organs possibly responsible for attenuation. The comparison of both studies in 25 normal subjects by visual interpretation and circumferential profiles analysis showed a complete suppression of significant attenuation in the inferior wall in prone studies. In addition and consequently, the standard deviation of activity in this area was markedly reduced and became close to its value in anterior and lateral walls. This simple technique now routinely performed in over 400 patients drastically improves specificity in the evaluation of inferior wall abnormalities by suppressing attenuation artifacts and, incidently, the effect of high individual variability in left phrenic and subphrenic anatomic configuration.

  2. Prediction of functional recovery of the left ventricle after coronary revascularization in patients with prior anterior myocardial infarction: a myocardial integrated backscatter study.

    PubMed

    Ito, Takahide; Suwa, Michihiro; Suzuki, Shuji; Tanimura, Mitsuhiro; Suzuki, George; Kobashi, Ayaka; Nakamura, Tomomi; Miyazaki, Sadae; Kitaura, Yasushi

    2002-10-01

    Cyclic variation (CV) of myocardial integrated backscatter (IBS), which reflects intrinsic contractile performance, can predict myocardial viability in patients with a reperfused acute myocardial infarction (MI), but the use of this method has not been validated for chronic left ventricular (LV) dysfunction. The aim of this study was to examine whether myocardial IBS was useful for predicting LV functional recovery after coronary revascularization in 17 patients with prior anterior MI and LV dysfunction (ejection fraction <50%). Within 24 h of the revascularization procedure (percutaneous transluminal coronary angioplasty or coronary stenting), IBS curves were obtained by placing the region of interest on the anterior wall on the short-axis IBS image. The patients had repeat left heart catheterization at 3 or 6 months after the revascularization procedure, and were grouped according to the patterns of the IBS curve within the anterior wall. In 8 patients (group A), the IBS curve had a synchronized pattern with the magnitude of CV > or = 3.5, and in the remaining 9 patients (group B), the curve had either an asynchronized pattern or the magnitude of CV was less than 3.5 dB even in the case of synchronized pattern, or both. At baseline, there were no significant differences in LV functional indices between the 2 groups. After the follow-up period, the LV end-systolic volume decreased (75 +/- 21 ml to 56 +/- 20ml, p = 0.05), LV ejection fraction increased (35 +/- 12% to 50 +/- 14%, p = 0.014), and LV end-diastolic pressure decreased (19 +/- 10 mmHg to 13 +/- 6 mmHg, p = 0.02) in group A, whereas only the LV ejection fraction increased (34 +/- 9% to 40 +/- 11%, p = 0.03) in group B; LV end-systolic volume (72 +/- 19 ml to 66 +/- 16 ml, p = 0.126) and LV end-diastolic pressure (18 +/- 12 mmHg to 14 +/- 8 mmHg, p = 0.184) showed no significant changes. In conclusion, IBS is valuable for predicting LV functional recovery after coronary revascularization in patients with LV dysfunction caused by a remote anterior MI. A large-scale study is be needed to establish these data. PMID:12381081

  3. Severe limb pain suppresses chest pain in a patient with anterior myocardial infarction.

    PubMed

    Canpolat, U; Kaya, E B; Aytemir, K; Kabakçı, G

    2012-09-01

    Cardiac complications of chest trauma range from arrhythmias and valvular avulsions to myocardial contusion, rupture, and--rarely--myocardial infarction. Herein, we described a 44-year-old male patient who presented to the hospital after receiving a blow from a fist directly to the chest and fingertip amputation during a fight; anterior myocardial infarction without any chest pain was coincidentally detected. Our case illustrates the importance of electrocardiography in the initial evaluation of patients with chest trauma and suspected injury to the coronary arteries. PMID:22407423

  4. Anterior thoracic wall traumatic lymphocele: a case report.

    PubMed

    Ballas, K; Rafailidis, S; Simeonidis, N; Papanikolaou, K; Aimoniotou, E; Sakadamis, A K

    2007-01-01

    Traumatic lymphoceles are usually the result of surgical injuries or blunt trauma. Although usually described in the pelvis after radical pelvic node dissection or kidney transplantation, traumatic lymphoceles are rare. Diagnosis is based on CT scan and confirmed by fine needle aspiration with biochemical analysis. Treatment modalities are not standardized and different techniques have been described. We report herein a case of anterior thoracic wall lymphocele due to blunt trauma treated in our department. PMID:17405607

  5. Thallium-201 evidence that anterior ST segment depression during early acute inferior myocardial infarction reflects septal or posterolateral ischemic injury

    SciTech Connect

    Lew, A.; Weiss, T.; Maddahi, J.; Geft, I.; Shah, P.K.; Swan, H.J.C.; Ganz, W.; Berman, D.

    1984-01-01

    The pathogenesis of anterior (ANT) ST segment depression (ST decreasing) during acute inferior myocardial infarction (IMI) remains controversial. To evaluate the role of septal (S) or posterolateral (PL) ischemic injury (IS), resting thallium-201 (T1-201) scintigrams closely timed to ECG findings (mean 21+-21 minutes) were evaluated in 49 consecutive pts during the first 5 hrs of a first acute IMI. ANT ST decreasing (any lead V1-V4) of greater than or equal to 1.0 mm was considered significant. All 49 pts had inferior T1-201 defects. In all 38 pts with ANT ST decreasing, there was T1-201 evidence of PL and/or S IS. In 9 of 11 pts without ANT ST decreasing, IS was confined to the inferior wall. The magnitude of inferior lead ST segment elevation correlated well with ST decreasing in leads 1 and AVL (r=0.88) and poorly with ST decreasing in anterior leads (r=0.32, supporting the concept that in acute IMI, ST decreasing in 1 and AVL is a reciprocal electrical phenomenon, but that ANT ST decreasing has a different pathogenesis. Thus the authors conclude that anterior ST depression in acute inferior myocardial infarction is associated with additional septal and/or posterolateral ischemic injury and does not reflect a benign reciprocal electrical phenomenon.

  6. Quantification of regional myocardial wall motion by cardiovascular magnetic resonance

    PubMed Central

    Jiang, Kai

    2014-01-01

    Cardiovascular magnetic resonance (CMR) is a versatile tool that also allows comprehensive and accurate measurement of both global and regional myocardial contraction. Quantification of regional wall motion parameters, such as strain, strain rate, twist and torsion, has been shown to be more sensitive to early-stage functional alterations. Since the invention of CMR tagging by magnetization saturation in 1988, several CMR techniques have been developed to enable the measurement of regional myocardial wall motion, including myocardial tissue tagging, phase contrast mapping, displacement encoding with stimulated echoes (DENSE), and strain encoded (SENC) imaging. These techniques have been developed with their own advantages and limitations. In this review, two widely used and closely related CMR techniques, i.e., tissue tagging and DENSE, will be discussed from the perspective of pulse sequence development and image-processing techniques. The clinical and preclinical applications of tissue tagging and DENSE in assessing wall motion mechanics in both normal and diseased hearts, including coronary artery diseases, hypertrophic cardiomyopathy, aortic stenosis, and Duchenne muscular dystrophies, will be discussed. PMID:25392821

  7. ST-Segment Elevation in the Right Precordial Leads in Patients with Acute Anterior Myocardial Infarction

    PubMed Central

    Pourafkari, Leili; Joudi, Saeid; Ghaffari, Samad; Tajlil, Arezou; Kazemi, Babak; Nader, Nader D.

    2016-01-01

    Background: Elevation of ST segment in leads V3R/ V4R, which is commonly encountered in right ventricular myocardial infarction, may also occur in patients with anterior ST elevation myocardial infarction (STEMI). However, the clinical impact of this finding in the setting of anterior myocardial infarction is not well understood. Aims: We aimed to investigate the prognostic value of ST segment elevation in leads V3R/V4R in patients with first acute anterior myocardial infarction. Study Design: Prospective cohort study. Methods: Right precordial leads V3R/V4R were recorded in 111 patients admitted with first time anterior myocardial infarction. Patients were allocated into two groups based on the presence or absence of ST elevation in leads V3R/V4R. Demographic, biochemical and echocardiographic data, as well as the angiographic information, were recorded. In-hospital and 3 month mortality, and major adverse cardiac events (MACE), death, heart failure and ventricular dysrhythmia were also compared. Results: ST elevation in lead V3R or V4R was present in 72 out of 111 patients (64.9%). Involvement of the proximal part of the left anterior descending (LAD) artery was not different in the two groups (44.4% of patients with elevation vs. 53.8% of patients without elevation, p=0.22). Post-myocardial infarction complications, mortality and major adverse cardiac events were similar in the two groups. Left ventricular ejection fraction (LVEF) was significantly lower in patients with ST elevation in V3R/V4R (35 %±8 vs. 38 %±8, p=0.02). Twenty three out of 111 patients (20.7%) developed heart failure, which was similar in the two groups [16 (22.2%) of patients with ST elevation vs. 7 (17.9%) of patients without ST elevation, p=0.39]. Conclusion: Although ST elevation in V3R/V4R can be present in patients with left anterior descending artery occlusion, it does not seem to predict the prognosis. Lower left ventricular ejection fraction in this group may play a role in the long-term prognosis; however, this issue needs further investigation.

  8. Quantitative anatomical labeling of the anterior abdominal wall

    NASA Astrophysics Data System (ADS)

    Allen, Wade M.; Xu, Zhoubing; Asman, Andrew J.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-03-01

    Ventral hernias (VHs) are abnormal openings in the anterior abdominal wall that are common side effects of surgical intervention. Repair of VHs is the most commonly performed procedure by general surgeons worldwide, but VH repair outcomes are not particularly encouraging (with recurrence rates up to 43%). A variety of open and laparoscopic techniques are available for hernia repair, and the specific technique used is ultimately driven by surgeon preference and experience. Despite routine acquisition of computed tomography (CT) for VH patients, little quantitative information is available on which to guide selection of a particular approach and/or optimize patient-specific treatment. From anecdotal interviews, the success of VH repair procedures correlates with hernia size, location, and involvement of secondary structures. Herein, we propose an image labeling protocol to segment the anterior abdominal area to provide a geometric basis with which to derive biomarkers and evaluate treatment efficacy. Based on routine clinical CT data, we are able to identify inner and outer surfaces of the abdominal walls and the herniated volume. This is the first formal presentation of a protocol to quantify these structures on abdominal CT. The intra- and inter rater reproducibilities of this protocol are evaluated on 4 patients with suspected VH (3 patients were ultimately diagnosed with VH while 1 was not). Mean surfaces distances of less than 2mm were achieved for all structures.

  9. Malignant Schwannoma of Anterior Abdominal Wall: Report of a Case

    PubMed Central

    Khorgami, Zhamak; Nasiri, Shirzad; Rezakhanlu, Freshteh; Sodagari, Nassim

    2009-01-01

    Malignant schwannoma of the anterior abdominal wall nerves is extremely rare. Malignant peripheral nerve sheath tumors (MPNST) represent approximately 10% of all soft tissue sarcomas and it is found in 4% of patients with neurofibromatosis 1. We present a case of malignant schwannoma in a 28-year-old female patient with neurofibromatosis 1. She presented with a painful mass in the right upper quadrant of her abdomen. The tumor location was in the abdominal wall in explorative laparatomy and malignant schwannoma was diagnosed in pathologic assessment. The tumor recurred in 3 months and computed tomography showed two masses in the right side of abdominopelvic cavity. Thereafter, second complete surgical resection was performed and pathologic finding was the same. In spite of administering chemotherapy after second surgery,the tumor recurred and magnetic resonance imaging finding showed a huge heterogeneously enhancing mass with adhesion to the inner side of the abdominal wall. The patient died because of acute respiratory failure due to multiple bilateral pulmonary metastases. Tumor location and rapid recurrence was unique in our patient. Keywords Malignant peripheral nerve sheath tumor; Malignant schwannoma; Abdominal wall PMID:22461875

  10. Early Indium-111 antimyosin scintigraphy for assessment of regional wall motion asynergy on discharge after myocardial infarction

    SciTech Connect

    van Vlies, B.; Baas, J.; Visser, C.A.; van Royen, E.; Delemarre, B.J.; Bot, H.; Dunning, A.J. )

    1990-01-01

    To assess the relation between early Indium-111 monoclonal antimyosin antibody scintigraphy and degree of regional asynergy on discharge, 38 patients with a first acute myocardial infarct were studied (18 anterior, 20 inferoposterior infarctions). In 21 patients thrombolytic therapy was administered. On the first day of myocardial infarction, 80 MBq Indium-111 Antimyosin was injected. Planar images, anterior, lateral and left anterior oblique, were made 24 hours later. Localized myocardial uptake was present in 37/38 patients, and was evaluated for Count Density Index (count density of infarct zone/left lung count density) in the left anterior oblique images, which displayed the infarct zone well. Regional asynergy on discharge was evaluated by cross-sectional echocardiography and defined mild (hypokinesia) or severe (akinesia or dyskinesia). Count density index was significantly lower in 15 patients with mild asynergy, compared with 22 patients with severe asynergy (1.61 +/- 0.25 vs. 2.42 +/- 0.40, p less than 0.001). This difference was present in both patient groups treated with or without thrombolysis. We conclude that early count density index, reflecting the amount of local necrosis, is highly correlated to the ultimate degree of wall motion impairment.

  11. Survival after left ventricular free wall rupture due to acute myocardial infarction

    PubMed Central

    Hosseinzadeh-Maleki, Mahmood; Valizadeh, Niloufar; Rafatpanah, Niloofar; Moezi, Seyed Ali

    2015-01-01

    BACKGROUND Left ventricular free wall rupture is a frequent catastrophic complication of acute myocardial infarction (AMI) and occurs in 1-3% of patients with acute myocardial infarction; it is the third most common cause of death caused by acute myocardial infarction, too. CASE REPORT We describe acute left ventricular free wall rupture due to acute myocardial infarction in a 60-year-old man. He was survived after urgent surgical intervention. CONCLUSION The long-term survivors of free wall rupture repair have not been extensively reported; early diagnosis is very critical and immediate surgical repair is the treatment of choice. PMID:26715937

  12. Prognostic significance of isolated left anterior hemiblock and left axis deviation in the course of acute myocardial infarction.

    PubMed Central

    Büyüköztürk, K; Korkut, F; Meric, M; Deligönül, U; Ozkan, E; Ozcan, R

    1977-01-01

    In 700 patients with acute myocardial infarction admitted to the intensive coronary care unit of our hospital, the incidence and significance of left anterior hemiblock and left axis deviation has been studied in the acute phase of disease. In 102 (14.6%) of the 700 patients, isolated left axis deviation (mean QRS axis-45 degrees) was found and 69 of them (9.9%) met the criteria of left anterior hemiblock. Of the 69 patients with left anterior hemiblock, 61 had acute anterior myocardial infarction, 5 had inferior infarction, and 3 had subendocardial infarction. The anterior hemiblock was transient in 5 patients, but persisted in 64. All patients with and without isolated left anterior hemiblock and left axis deviation were compared statistically with reference to mortality rate and the incidence of arrythmias; no significant difference was noted. However, in patients over the age of 65 and also in those with hypertension, the incidence of left axis deviation was significantly higher (P less than 0.05 and P less than 0.001, respectively). It was concluded that isolated left anterior hemiblock and left axis deviation occurring in the course of acute myocardial infarction no influence on the prognosis of acute myocardial infarction. PMID:588375

  13. Septal and Anterior Reverse Mismatch of Myocardial Perfusion and Metabolism in Patients With Coronary Artery Disease and Left Bundle Branch Block

    PubMed Central

    Wang, Jian-Guang; Fang, Wei; Yang, Min-Fu; Tian, Yue-Qin; Zhang, Xiao-Li; Shen, Rui; Sun, Xiao-Xin; Guo, Feng; Wang, Dao-Yu; He, Zuo-Xiang

    2015-01-01

    Abstract The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD). Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated. The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026). In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval. PMID:25997045

  14. Myocardial infarction and subtotal obstruction of the anterior descending coronary artery caused by trauma in a football player.

    PubMed

    García Gallego, F; Sotillo Martí, J; Pérez Blasco, P

    1986-07-01

    A 26-year-old professional football player had a myocardial infarction when he was practicing his sport. He arrived at the hospital 1 hour later. Angiographic study showed critical stenosis and distal thrombosis in the anterior descending coronary artery. Intracoronary thrombolytic and vasodilator therapy followed by dilatation angioplasty resolved these coronary obstructions. We conclude that several factors contributed to the origin of myocardial infarction in this case including a complicated atheromatous plaque, formation of thrombus and coronary spasm. PMID:3733264

  15. Permanent ligation of the left anterior descending coronary artery in mice: a model of post-myocardial infarction remodelling and heart failure.

    PubMed

    Muthuramu, Ilayaraja; Lox, Marleen; Jacobs, Frank; De Geest, Bart

    2014-01-01

    Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure. Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling. Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail. PMID:25489995

  16. Electrocardiographic changes of acute lateral wall myocardial infarction: a reappraisal based on scintigraphic localization of the infarct

    SciTech Connect

    Movahed, A.; Becker, L.C.

    1984-10-01

    To determine how often acute lateral myocardial infarcts may be electrocardiographically silent, a new approach was utilized in which subjects were selected by admission thallium scintigraphy. Thirty-one patients with their first infarction were identified with moderate to severe perfusion defects of the lateral and posterolateral walls, persistent over 7 days and associated with severe wall motion abnormalities. Patients with involvement of the anterior, septal or inferior regions were not included. In nine patients, the perfusion defect extended to the anterolateral wall: all developed ST elevation and Q waves in at least one of the lateral leads (I, aVL or V6) but none showed changes in the inferior leads (II, III or aVF). In the other 22 patients, the perfusion defect was limited to the lateral and posterolateral walls: only 12 showed ST elevations (inferior leads only in 7, lateral leads only in 2, both leads in 3) and only 9 developed Q waves (inferior in all). In 8 of these 22 patients, the infarct was silent in the sense that no ST segment elevation or Q waves were seen, although ST depressions or T wave inversions, or both, in all but one patient were compatible with subendocardial infarction. The results indicate that the standard electrocardiogram is insensitive to changes in the lateral and posterolateral regions. Additional diagnostic studies are needed for proper localization and sizing of acute myocardial infarcts.

  17. Correlation of regional wall motion after acute myocardial infarction with coronary arteriographic findings

    SciTech Connect

    Tamski, N.; Yasuda, T.; Leinbach, R.C.; Gold, H.K.; Kawamura, Y.; McKusick, K.A.; Strauss, H.W.

    1985-05-01

    Changes of wall motion after acute myocardial infarction (MI) were compared with stenosis (>50%) of major vessels on coronary arteriography (CAG) performed within 4 weeks. Multigated blood-pool scans were obtained within 15 hours of MI and at 10 days in 37 patients who received standard therapy. Regional wall motion was quantitatively analyzed as mean chord shortening (MCS) in 6 sector segments (60 degrees) in the anterior and LAO views. Akinetic segments (AkS: MCSless than or equal to15%) (n=97) and normal segments (NS: MCSgreater than or equal to30%) (n=68) at the initial scan were selected for this study. Ten days after MI, MCS in AkS increased (6.0 +- 13.4%;p<0.001), whereas MCS in NS decreased (-7.0 +- 13.6%; p<0.001). The MCS changes in these segments were compared with CAG findings in multivessel disease (MVD) (n=20) and single-vessel disease (SVD) (n=17). SVD showed significant MCS change both in AkS and NS (p<0.001 each). This change was marked in RCA/Cx disease in SVD (p<0.001 each). These data suggest 1) improvement of AkS at 10 days after MI was more often seen in SVD. 2) Among SVD, their improvement was higher in RCA/Cx than LAD. 3) NS showed higher wall motion at the acute stage than 10 days after MI. 4) This hyperkinetic wall motion in NS was more often seen in SVD.

  18. [Acute anterior myocardial infarction presented with cardiogenic shock in a patient on herbal medication].

    PubMed

    Güneş, Hakan; Küçükdurmaz, Zekeriya; Karapınar, Hekim; Gül, İbrahim

    2012-04-01

    Uncontrolled usage of herbal medications may cause problems that can lead to serious complications, including death. Panax is thought to have hypocholesterolemic, anticarcinogenic, antiinflammatory, and antimicrobial effects via its saponin ingredient and positive inotropic effects via its panax ginseng effect. However, clinical studies have shown that it can increase the low-density lipoprotein (LDL) levels secondary to its hypocholesterolemic effect, have a hypertensive effect in chronic users via ginseng abuse syndrome, and also have hypotensive effects. Here, we present a case with typical angina pectoris in which coronary angiography was suggested but refused. The male patient initiated panax therapy and presented to our emergency department with diffuse anterior myocardial infarction and cardiogenic shock, and was discharged after appropriate therapy. PMID:22864324

  19. Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies

    PubMed Central

    2010-01-01

    Background Left ventricular thrombus(LVT] formation is a frequent complication in patients with acute anterior myocardial infarction(MI). LVT is associated with increased risk of embolism and higher mortality rates after acute MI. Anticardiolipin antibodies (ACA) are immunoglobulins that react with phospholipid-binding proteins interfering with the prothrombin activator complex. The effects of phospholipids on pathophysiology of cardiovascular thrombotic events are well known. In this study, we aimed to evaluate the importance of clinical and biochemical parameters including anticardiolipin antibodies on left ventricular thrombus formation after acute anterior MI. Methods and Results Seventy patients with a first anterior AMI were prospectively and consecutively enrolled. Patients with previous MI, autoimmune disease, collagen vascular disease and arterial or venous thrombosis history were excluded from this study. At the time of hospitalization, key demographic and clinical characteristics were collected including age, gender, ethanol intake and presence of traditional risk factors for atherosclerosis (hypertension, diabetes, smoking, hyperlipidemia, positive family history). Patients were evaluated for echocardiographic data, blood chemistry and ACA. Two-dimensional and Doppler echocardiographic examinations were performed in all patients within the first week and at 14 days after MI. LV thrombus was detected in 30 (42.8%) patients. ACA IgM levels were significantly higher in the patient group with LV thrombus than in the group without thrombus (12.44 4.12 vs. 7.69 4.25 mpl, p = 0,01). ACA IgG levels were also found higher in the group with LV thrombus (24.2 7.5 vs.17.98 6.45 gpl, p = 0.02). Multivariate analyses revealed diabetes mellitus, higher WMSI, lower MDT and higher ACA IgM and higher ACA IgG levels as independent predictors of left ventricular thrombus formation. Conclusions Our data demonstrate that beside the low ejection fraction, lower MDT and higher wall motion score index, modestly elevated ACA IgM and ACA IgG levels are associated with LV thrombus formation in patients with anterior MI. PMID:20849660

  20. Pathophysiology of technetium-99m stannous pyrophosphate and thallium-201 scintigraphy of acute anterior myocardial infarcts in dogs.

    PubMed Central

    Buja, L M; Parkey, R W; Stokely, E M; Bonte, F J; Willerson, J T

    1976-01-01

    In 17 dogs with acute myocardial infarcts produced by ligation of the proximal left anterior descending coronary artery, a comparative study was made of myocardial scintigrams obtained with technetium-99m stannous pyrophosphate (99mTc-PYP) and thallium-201 (201T1), tissue levels of 99mTc-PYP and 201T1 uptake, histopathologic alterations, and regional myocardial perfusion measured with radioactive microspheres. 9 of the 10 hearts examined histologically had transmural infarcts with outer peripheral, inner peripheral, and central zones characterized by distinctive histopathologic features. A progressive reduction in myocardial blood flow was demonstrated between normal myocardium and the centers of the infarcts, and correlated well with progressive reduction in 201T1 upatke in the same regions. Marked 99mTc-PYP concentration occurred in areas with partial to homogeneous myocardial necrosis and residual perfusion located in the outer peripheral regions of the infarcts. The latter areas also were characterized by the presence of muscle cell calcification. The patterns of distribution of 99mTc-PYP and 201T1 explained the filling defects on 201T1 myocardial scintigrams and the doughnut patterns on 99mTc-PYP myocardial scintigrams in dogs with transmural infarcts. One dog with a subendocardial infarct had a small homogeneous area of activity on the 99mTc-PYP myocardial scintigram, and showed marked uptake of 99mTc-PYP in subendocardial areas of extensive necrosis and calcification still receiving some coronary perfusion. Thus, the data indicate that the status of regional myocardial perfusion is a key determinant for the occurrence of distinctive patterns of myocardial necrosis and for the scintigraphic detection of acute myocardial infarcts with 99mTc-PYP and 201T1. Images PMID:180053

  1. Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

    PubMed Central

    Ko, Jung Hwa; Bae, Jaeman; Lee, Won Moo; Koh, A Ra; Boo, Hyeyeon; Lee, Eunhyun; Hong, Jin Hwa

    2015-01-01

    Objective To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. Methods We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. Results The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. Conclusion LAVH is effective and safe for women with anterior wall adherence after cesarean section. PMID:26623415

  2. MRI measurements of left ventricular systolic wall thickening compared to regional myocardial perfusion as determined by 201Tl SPECT in patients with coronary artery disease.

    PubMed

    Kleinhans, E; Altehoefer, C; Arnold, C; Buell, U; vom Dahl, J; Uebis, R

    1991-04-01

    Magnetic resonance imaging (MRI) of the left ventricle (LV) is an excellent method of measuring systolic wall thickening (SWT). The aim of the present study was (a) to describe a new approach for measurement of SWT and (b) to define the relationship between SWT and regional myocardial perfusion as determined by 201Tl SPECT. 79 patients -51 with and 28 without history of earlier myocardial infarction - underwent SPECT and, within the next two weeks. MRI. End-diastolic and end-systolic spin echo images were obtained by a reduced permutation technique. For MRI measurements, only long-axis sections through the LV in the equatorial plane were used. Slice orientation was selected according to the findings of SPECT, imaging the infarcted wall segment by single or double angulation. At 7 equidistant points around the LV wall SWT was measured and compared with the corresponding regional myocardial uptake values from SPECT in percent of maximal perfusion. Wall thickness of the anterior wall was normal. Because the majority of myocardial infarctions were posterior-inferior (55%), thickness of the posterior wall was markedly decreased. A close relationship of perfusion to SWT was found. Higher perfusion areas (greater than 50% of maximal TI uptake) corresponded with normal SWT (greater than 3.0 mm), a marked decrease of SWT (less than 1 mm) was found in areas with perfusion deficits (less than 40%). Thus, a 201TI uptake value at rest of 41-50% of the respective myocardial maximum acts as a threshold by discriminating normal from severely reduced SWT. PMID:2047242

  3. Unusual Presentations of Actinomycosis; Anterior Abdominal Wall and Appendix: Report of Three Cases

    PubMed Central

    Karateke, Faruk; Özyazıcı, Sefa; Menekşe, Ebru; Daş, Koray; Özdoğan, Mehmet

    2013-01-01

    Background: Primary actinomycosis of the anterior abdominal wall and appendix are very rare clinical entities. An accurate diagnosis is generally obtained by histological examination, and treatment often requires surgical resection. Case Report: In this study we presented two cases of primary actinomycosis involving the anterior abdominal wall and a third one located in the appendix. Conclusion: Actinomyces Israelii can involve all anatomic structures of the abdomen. Although preoperative diagnosis is difficult, the combination of surgery and antibiotic treatment results in complete treatment in the majority of cases. PMID:25207127

  4. Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction

    PubMed Central

    Hollar, Laura; Hartness, Owen; Doering, Tracey

    2015-01-01

    Wellens’ syndrome, also known as LAD coronary T-wave syndrome or the ‘widow maker’, is a pre-infarction syndrome with non-classical ischemic ECG changes and unremarkable cardiac biomarkers. This syndrome continues to be a ‘can't miss’ for the clinician as delay in urgent angiography and intervention can result in anterior myocardial infarction, left ventricular dysfunction, arrhythmias, and death. We describe a case followed by a discussion of identification criteria and clinical implications. PMID:26486122

  5. Repression of wall shear stress inside cerebral aneurysm at bifurcation of anterior cerebral artery by stents.

    PubMed

    Yamaguchi, Ryuhei; Tanaka, Gaku; Liu, Hao; Ujiie, Hiroshi

    2016-04-01

    The effect of a simple bare metal stent on repression of wall shear stress inside a model cerebral aneurysm was experimentally investigated by two-dimensional particle image velocimetry in vitro. The flow model simulated a cerebral aneurysm induced at the apex of bifurcation between the anterior cerebral artery and the anterior communicating artery. Wall shear stress was investigated using both stented and non-stented models to assess the simple stent characteristics. The flow behavior inside the stented aneurysm sac was unusual and wall shear stress was much smaller inside the aneurysm sac. Stent placement effectively repressed the temporal and spatial variations and the magnitude of wall shear stress. Hence, there is an effective possibility that would retard the progress of cerebral aneurysms by even simple stent. PMID:25813684

  6. Anatomic Distribution of Nerves and Microvascular Density in the Human Anterior Vaginal Wall: Prospective Study

    PubMed Central

    Li, Ting; Liao, Qinping; Zhang, Hong; Gao, Xuelian; Li, Xueying; Zhang, Miao

    2014-01-01

    Background The presence of the G-spot (an assumed erotic sensitive area in the anterior wall of the vagina) remains controversial. We explored the histomorphological basis of the G-spot. Methods Biopsies were drawn from a 12 o’clock direction in the distal- and proximal-third areas of the anterior vagina of 32 Chinese subjects. The total number of protein gene product 9.5–immunoreactive nerves and smooth muscle actin–immunoreactive blood vessels in each specimen was quantified using the avidin-biotin-peroxidase assay. Results Vaginal innervation was observed in the lamina propria and muscle layer of the anterior vaginal wall. The distal-third of the anterior vaginal wall had significantly richer small-nerve-fiber innervation in the lamina propria than the proximal-third (p = 0.000) and in the vaginal muscle layer (p = 0.006). There were abundant microvessels in the lamina propria and muscle layer, but no small vessels in the lamina propria and few in the muscle layer. Significant differences were noted in the number of microvessels when comparing the distal- with proximal-third parts in the lamina propria (p = 0.046) and muscle layer (p = 0.002). Conclusions Significantly increased density of nerves and microvessels in the distal-third of the anterior vaginal wall could be the histomorphological basis of the G-spot. Distal anterior vaginal repair could disrupt the normal anatomy, neurovascular supply and function of the G-spot, and cause sexual dysfunction. PMID:25379731

  7. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

    PubMed Central

    Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2014-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

  8. Mechanotransduction of trigeminal ganglion neurons innervating inner walls of rat anterior eye chambers.

    PubMed

    Meng, Qingli; Fang, Peng; Hu, Zhuangli; Ling, Yun; Liu, Haixia

    2015-07-01

    To address mechanoreceptive roles of trigeminal ganglion (TG) nerve endings in the inner walls of rat anterior eye chambers, we investigated the mechanotransduction process and mechanosensitive (MS) channel on somata of TG neurons innervating this area in vitro. Rat TG neurons innervating inner walls of anterior chambers were labeled by anterior chamber injection of 1,1'-dilinoleyl-3,3,3',3'-tetramethylindocarbocyanine, 4-chlorobenzenesulfonate (FAST DiI). The neuronal cell bodies were voltage clamped using a whole cell patch-clamp technique, while it was deformed by ejection of bath solution to verify mechanotransduction. Immunofluorescence staining was performed on sections of TG ganglia to determine the specific MS channel proteins. Mechanical stimuli induced MS currents in 55 out of 96 FAST DiI-labeled TG neurons. The MS currents exhibited mechanical intensity-dependent and clamp voltage-dependent characteristics. Mechanical stimulation further enhanced the membrane potential and increased the frequency of action potentials. Transient receptor potential ankyrin 1 (TRPA1), TRP vanilloid 4 (TRPV4), acid-sensing ion channel (ASIC) 2 and ASIC3 channel proteins were expressed in FAST DiI-labeled TG neurons. The inhibitory effect of HC-030031, a specific inhibitor of TRPA1, on MS currents demonstrated that TRPA1 was an essential MS channel protein. Taken together, our results show that mechanical stimuli induce MS currents via MS channels such as TRPA1 to trigger mechanotransduction in TG neurons innervating inner walls of anterior chambers. Our results indicate the existence of mechanoreceptive TG nerve endings in inner walls of anterior chambers. Whether the mechanoreceptive TG nerve endings play a role in intraocular pressure sensation warrants further investigation. PMID:25904679

  9. Long term follow up of patients with anterior myocardial infarction complicated by left ventricular thrombus in the thrombolytic era.

    PubMed Central

    Mooe, T.; Teien, D.; Karp, K.; Eriksson, P.

    1996-01-01

    OBJECTIVES: To examine the appearance and resolution of left ventricular thrombi and to study the relation between thrombus and mortality during long term follow up after anterior myocardial infarction. DESIGN: Ninety nine consecutive patients were prospectively studied until the last included patient had been followed for one year. Streptokinase and aspirin were used routinely, anticoagulants only after a decision by the attending physician. Echocardiography was performed within 3 d of admission, before discharge, and after one, three, and 12 months. SETTING: Umeå University Hospital, a teaching hospital in Northern Sweden. MAIN OUTCOME MEASURES: Left ventricular thrombus, segmental myocardial function, and mortality during follow up. RESULTS: Thirty patients (30%) had a thrombus on discharge. One month, three months, and 12 months after hospital discharge, the thrombus had resolved in 81%, 84%, and 90% of the patients, respectively. The proportion of resolved thrombi at one month was high irrespective of whether anticoagulants were given (10/11, 91%) or not (12/16, 75%), P = 0.4. New thrombi appeared in 12 patients after discharge and resolution and reapperance of thrombi continued during the follow up period. Patients who developed a thrombus during the hospital stay (n = 44, 44%) had more extensive myocardial dysfunction on discharge (P < 0.001) and significantly higher mortality during the follow up period than those without a thrombus (23% v 7%, P < 0.01). CONCLUSIONS: With routine thrombolytic and aspirin treatment of anterior myocardial infarction, left ventricular thrombi usually resolve during the first month after hospital discharge. Appearance and resolution of thrombi continue, however, in a significant proportion of the patients during long term follow up. A left ventricular thrombus during the initial hospital stay is associated with high long term mortality. PMID:8800987

  10. Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman.

    PubMed

    Yiangou, Kyriakos; Papadopoulos, Kyriacos; Azina, Chara

    2016-04-01

    Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis and treatment of this rare condition is a challenge, but prompt recognition and appropriate early choice of angioplasty or surgery can lead to a good outcome. We report the case of a postmenopausal 54-year-old woman who presented with anterior myocardial infarction caused by spontaneous dissection of the left anterior descending coronary artery after she had lifted a heavy weight while gardening. The patient was treated successfully by means of angioplasty and the implantation of 3 drug-eluting stents. In addition to presenting the patient's case, we review the topical medical literature. PMID:27127443

  11. Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman

    PubMed Central

    Papadopoulos, Kyriacos; Azina, Chara

    2016-01-01

    Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis and treatment of this rare condition is a challenge, but prompt recognition and appropriate early choice of angioplasty or surgery can lead to a good outcome. We report the case of a postmenopausal 54-year-old woman who presented with anterior myocardial infarction caused by spontaneous dissection of the left anterior descending coronary artery after she had lifted a heavy weight while gardening. The patient was treated successfully by means of angioplasty and the implantation of 3 drug-eluting stents. In addition to presenting the patient's case, we review the topical medical literature. PMID:27127443

  12. Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery.

    PubMed

    Nakazato, Jun; Hirata, Kazuhito; Wake, Minoru

    2014-01-01

    A 49-year-old woman developed angina at rest. A CT of the coronary artery revealed that the left anterior descending artery arose from the right coronary artery, and traversed between the aorta and pulmonary trunk. An exercise stress myocardial scintigraphy did not reproduce myocardial ischaemia or anginal symptoms. A coronary angiography did not show any atherosclerotic changes. Finally, an ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery and the left anterior descending artery. Surgical correction of the anomaly was deferred and the patient was managed with medications to control spasm with good clinical outcome. PMID:24920513

  13. Comparison of contrast angiography and two-dimensional echocardiography for the evaluation of left ventricular regional wall motion abnormalities after acute myocardial infarction.

    PubMed

    Lundgren, C; Bourdillon, P D; Dillon, J C; Feigenbaum, H

    1990-05-01

    Regional left ventricular wall motion abnormalities were assessed using 2-dimensional echocardiography and contrast ventriculography within 12 hours of the onset of chest pain in 20 patients with acute myocardial infarction (AMI); 10 patients had anterior infarctions and 10 had inferior. End-diastolic and end-systolic sinus beats from right anterior oblique contrast ventriculograms were analyzed using the center-line chord technique with both a standard overlap method of chord assignment and a nonoverlap method. Echocardiograms were obtained in parasternal long- and short-axis and apical 2- and 4-chamber views and analyzed using a 16-segment scoring system to derive anterior and infero-posterolateral wall motion indexes using both overlap (10 segments for anterior, 8 inferior) as well as nonoverlap (9 segments anterior, 7 inferior) methods of segment assignment. There was a significant inverse correlation between the standard (nonoverlap) echocardiographic analysis and the standard (overlap) angiographic analysis for infarct regions (y = -0.43 X +1.11, r = -0.59, p less than 0.05). Fifteen of 18 patients with angiographic infarct regional score less than or equal to -1 standard deviation/chord had an echocardiographic index greater than or equal to 1.5, while 15 of 16 patients with echocardiographic regional infarct index greater than or equal to 1.5 had an angiographic score less than or equal to -1 standard deviation/chord. Correlation between the 2 methods for noninfarct territories was poor (r = -0.34) because the angiographic method assesses hyperkinesis while the echocardiographic method does not.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2330892

  14. Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma

    PubMed Central

    Kaur, Gurpreet; Sharma, Abha; Suneja, Amita; Guleria, Kiran

    2015-01-01

    Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury. PMID:26557574

  15. Alternative option in patients with multisegmental left anterior descending coronary artery disease for providing complete myocardial revascularization

    PubMed Central

    Gucu, Arif; Goncu, Tuğrul; Yavuz, Senol; Ozluk, Ozlem Arican; Eris, Cuneyt; Turk, Tamer; Ozyazıcıoglu, Ahmet; Vural, Hakan

    2014-01-01

    Objectives: The basic aim of surgical interventions in patients with coronary artery disease is to complete myocardial revascularization. In such patients, however, complementary revascularization techniques may require in patients with multisegmental left anterior descending disease. Among the different procedures, we performed an alternative option in patients with multisegmental lad disease for providing complete myocardial revascularization. Methods: This study consists of retrospective analysis of consecutive eight patients between january 2008 and august 2013. In all patients, the surgical procedure consisted of standard aortic and right atrial cannulations followed by coronary artery bypass grafting with cardiopulmonary bypass. At the lesions of non-lad vessels distal anastomoses were performed with saphenous vein graft. After that lad arteriotomies were performed at the proximal and the distal segment of coronary stenosis, and a bridge was formed with a short segment valveless svg. The left internal mammary artery was anastomosed on the bridge. Results: This innovative technique was performed successfully in all the patients. There were no morbidity and in-hospital mortality. At follow-up 1 year control, all the patients have no complications. In 2 patients, control angiogram showed a patent lima to a bridge anastomosis. Conclusions: Although our series has a small group population, we advocate that this is a safe, easy, and efficient technique for providing complete revascularization in multisegmental lad disease. This technique could be performed with the good result and easy implementation. It perfuses both the proximal and the distal segments of the multisegmental lad stenoses. PMID:24482700

  16. Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation

    PubMed Central

    Han, Pengfei; Xie, Yuping; Chen, Jianmin; Xiao, Ying; Kang, Y. James

    2013-01-01

    Clinical studies have demonstrated the predictive values of changes in electrocardiographic (ECG) parameters for the preexisting myocardial ischemic infarction. However, a simple and early predictor for the subsequent development of myocardial infarction during the ischemic phase is of significant value for the identification of ischemic patients at high risk. The present study was undertaken by using non-human primate model of myocardial ischemic infarction to fulfill this gap. Twenty male Rhesus monkeys at age of 2–3 years old were subjected to left anterior descending artery ligation. This ligation was performed at varying position along the artery so that it produced varying sizes of myocardial infarction at the late stage. The ECG recording was undertaken before the surgical procedure, at 2 h after the ligation, and 8 weeks after the surgery for each animal. The correlation of the changes in the ECG waves in the early or the late stage with the myocardial infarction size was analyzed. The R wave depression and the QT shortening in the early ischemic stage were found to have an inverse correlation with the myocardial infarction size. At the late stage, the R wave depression, the QT prolongation, the QRS score, and the ST segment elevation were all closely correlated with the developed infarction size. The poor R wave progression was identified at both the early ischemic and the late infarction stages. Therefore, the present study using non-human primate model of myocardial ischemic infarction identified the decreases in the R wave and the QT interval as early predictors of myocardial infarction. Validation of these parameters in clinical studies would greatly help identifying patients with myocardial ischemia at high risk for the subsequent development of myocardial infarction. PMID:23967258

  17. Elective minimally invasive coronary artery bypass: Shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study

    PubMed Central

    2012-01-01

    Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n = 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. Results One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p = 1). There were no significant differences in between both groups at all studied timepoints. Conclusion There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass. PMID:22809563

  18. Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis

    PubMed Central

    Sabanis, Nikos; Paschou, Eleni; Gavriilaki, Eleni; Mourounoglou, Maria; Vasileiou, Sotirios

    2015-01-01

    Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location. PMID:26301109

  19. Evolution of myocardial ischemia and left ventricular function in patients with angina pectoris without myocardial infarction and total occlusion of the left anterior descending coronary artery and collaterals from other coronary arteries

    SciTech Connect

    Juilliere, Y.; Marie, P.Y.; Danchin, N.; Karcher, G.; Bertrand, A.; Cherrier, F. )

    1991-07-01

    Repeated episodes of myocardial ischemia might lead to progressive impairment of left ventricular (LV) function. This radionuclide study assessed myocardial ischemia and LV function several years after documented coronary occlusion without myocardial infarction. Over 5 years, 24 consecutive patients, who underwent cardiac catheterization for angina pectoris without myocardial infarction, had isolated total occlusion of the left anterior descending coronary artery with well-developed collateral vessels. Five patients were successfully treated by coronary bypass grafting and 3 by coronary angioplasty. Among the 16 medically treated patients, 1 was lost to follow-up and 1 died (extracardiac death). The mean (+/- standard deviation) follow-up (14 patients) was 48 +/- 15 months. At follow-up, 8 patients still had clinical chest pain, 11 received antianginal therapy, 4 patients had no stress ischemia and the other 10 had greater than or equal to 1 sign of stress ischemia. All patients had a normal LV ejection fraction at rest (mean 60 +/- 3%; range 55 to 65%). Collateral circulation preserves LV function at the time of occlusion and, in some cases, prevents the development of myocardial ischemia; in patients with persisting myocardial ischemia after well-collateralized coronary occlusion, LV function is not impaired at long-term follow-up.

  20. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    SciTech Connect

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-11-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.

  1. Associated influence of hypertension and heart rate greater than 80 beats per minute on mortality rate in patients with anterior wall STEMI

    PubMed Central

    Davidovic, Goran; Iric-Cupic, Violeta; Milanov, Srdjan

    2013-01-01

    Acute myocardial infarction as a form of coronary heart disease is characterized by permanent damage/loss of anatomical and functional cardiac tissue. Diagnosis of STEMI includes data on anginal pain and persistent ST-segment elavation. According to the numerous epidemiological studies, arterial blood pressure and heart rate are offten increased especially during the first hours of pain due to domination of sympathetic response. We wanted to investigate the associated influence of heart rate greater than 80 beats per minute and hypertension on the mortality in patients with anterior wall STEMI. Research included 140 patients treated in Coronary Unit, Clinical Center Kragujevac form January 2001 to June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission, recorded on monitor and electrocardiogram. Data for history of hypertension were collected and blood pressure levels were measured in a lying position after 5 minutes of rest, and classified according to the VII JNC recommendations as confirmation of hypertension. Collected data were analyzed in SPSS 13.0 for Windows. Heart rate greater than 80 bpm influences the hospital mortality. Systolic blood pressure levels were higher in the survivors, while for the diastolic there was no difference. History of hypertension was singled out as a significant predictor of mortality without difference between the respondents with heart rate greater and lower than 80 bpm in the survivors and fatal. Increased heart rate and hypertension at admission are significant predictors of mortality in patients with anterior wall STEMI. PMID:23724155

  2. High precision Compton backscatter maps of myocardial wall dynamics. Theory and applications

    SciTech Connect

    McInerney, J.J.; Copenhaver, G.L.; Herr, M.D.; Morris, D.L.; Zelis, R. )

    1989-09-01

    Compton backscatter imaging (CBI) is a technique that uses x-rays scattered from the closed-chest surface of the heart to obtain high frequency (5 msec) and high precision (+/- 0.1 mm SD) measurements of regional surface displacements and velocities. These measurements are acquired in a three-dimensional format that allows the reconstruction of the epicardial surface and the creation of color coded displacement and velocity maps at many time points during the cardiac cycle. Applications of the technique are shown to characterize detailed regional normal wall displacement and velocity patterns, and the significant alteration of those patterns after coronary embolization. The technique is also applied to the characterization of early diastolic wall dynamics. CBI measurements show that a brief and somewhat paradoxical inward displacement of the anterior ventricular wall occurs during early diastole in normal canines. The wall dynamics associated with this inward displacement suggest a brief collapse of the ventricle subsequent to aortic valve closure. Diastolic collapse velocities and displacements are significantly altered subsequent to coronary occlusion with mean and maximum collapse velocities decreasing by 50% and concomitant inward displacements decreasing by 40%. Data acquisition with CBI is non-invasive, does not require contrast agents or radioisotopes, and uses low irradiation levels (125 kVp, 3-5 ma). The average radiation dose to the heart for a typical study is 250 mrem, significantly lower than that of other radiation based imaging techniques.

  3. Changes in Muscularis Propria of Anterior Vaginal Wall in Women with Pelvic Organ Prolapse

    PubMed Central

    Vetuschi, A.; D’Alfonso, A.; Sferra, R.; Zanelli, D.; Pompili, S.; Patacchiola, F.; Gaudio, E.; Carta, G.

    2016-01-01

    The objective of this study was to evaluate the morphological and immunohistochemical alterations of tissue removed from the upper third of anterior vaginal wall in a sample group of the female population presenting homogenous risk factors associated with pelvic organ prolapse (POP). The case study consisted of 14 patients with POP and there were 10 patients in the control group. Patient selection was carried on the basis of specific criteria and all of the patients involved in the study presented one or more of the recognized POP risk factors. Samples were taken from POP patients during vaginal plastic surgery following colpohysterectomy, and from control patients during closure of the posterior fornix following hysterectomy. Samples were processed for histological and immunohistochemical analyses for Collagen I and Collagen III, α-Smooth Muscle Actin (α-SMA), Platelet-Derived-Growth-Factor (PDGF), matrix metalloproteinase 3 (MMP3), tissue inhibitors metalloproteinase 1 (TIMP1), Caspase3. Immunofluorescence analyses for Collagen I and III and PDGF were also carried out. In prolapsed specimens our results show a disorganization of smooth muscle cells that appeared to have been displaced by an increased collagen III deposition resulting in rearrangement of the muscularis propria architecture. These findings suggest that the increase in the expression of collagen fibers in muscularis could probably be due to a phenotypic switch resulting in the dedifferentiation of smooth muscle cells into myofibroblasts. These alterations could be responsible for the compromising of the dynamic functionality of the pelvic floor. PMID:26972719

  4. Serial Clinical Examinations of 100 Patients Treated for Anterior Abdominal Wall Stab Wounds: A Cross Sectional Study

    PubMed Central

    Herfatkar, Mohammad Rasool; Mobayen, Mohammad Reza; Karimian, Mehdi; Rahmanzade, Fariba; Baghernejad Monavar Gilani, Sadaf; Baghi, Iraj

    2015-01-01

    Background: The current approach in stab wounds of the anterior abdominal wall is still unclear. Objectives: The goal of this study was to evaluate serial clinical examinations of patients with abdominal wall stab wounds referred to Poursina Hospital in Rasht. Patients and Methods: In a cross sectional study, 100 cases with stab wounds to the anterior abdominal wall were examined serially (admission time, 4, 8, 12, and 24 hours) after wound exploration. Serial hemoglobin test was performed every 8 hours. Laparotomy was performed in cases who were not hemodynamically stable or who showed symptoms of peritonitis. The results were analyzed with SPSS software version 21. Results: Ninety-one men (91%) and 9 women (9%) with mean age of 27 10.7 years were included. Coexisting injuries were prevalent in 12 cases. The duration of hospitalization was 1 day in 31%, 2 days in 30%, 3 - 4 days in 32% and more than 5 days in 7%. Late laparotomy was performed 12 hours after admission in 8% of patients due to peritonitis. There was visceral damage in these cases. No mortality occurred. The cost and duration of hospitalization was significantly higher in cases with coexisting injuries and those who underwent laparotomy. Conclusions: It seems serial clinical examinations are safe and decrease the cost and duration of hospitalization in stable patients with anterior abdominal wall stab wounds. PMID:26839861

  5. The spectrum of right ventricular involvement in inferior wall myocardial infarction: a clinical, hemodynamic and noninvasive study

    SciTech Connect

    Baigrie, R.S.; Haq, A.; Morgan, C.D.; Rakowski, H.; Drobac, M.; McLaughlin, P.

    1983-06-01

    The clinical experience with 37 patients with acute transmural inferior wall myocardial infarction who were assessed for evidence of right ventricular involvement is reported. On the basis of currently accepted hemodynamic criteria, 29 patients (78%) had evidence suggestive of right ventricular infarction. However, only 5 (20%) of 25 patients demonstrated right ventricular uptake of technetium pyrophosphate on scintigraphy. Two-dimensional echocardiography or isotope nuclear angiography, or both, were performed in 32 patients; 20 studies (62%) showed evidence of right ventricular wall motion disturbance or dilation, or both. Twenty-one patients demonstrated a late inspiratory increase in the jugular venous pressure (Kussmaul's sign). The presence of this sign in the clinical setting of inferior wall myocardial infarction was predictive for right ventricular involvement in 81% of the patients in this study. It is suggested that right ventricular involvement in this clinical setting is common and includes not only infarction but also dysfunction without detectable infarction, which is likely on an ischemic basis.

  6. Different Accumulation of Elements in Proximal and Distal Parts of the Left Anterior Descending Artery Beneath the Myocardial Bridge.

    PubMed

    Tohno, Yoshiyuki; Tohno, Setsuko; Minami, Takeshi; Pakdeewong-Ongkana, Nutcharin; Suwannahoy, Patipath; Quiggins, Ranida

    2016-05-01

    To elucidate the action of the myocardial bridge (MB) on the coronary artery, the authors first prepared the hearts with the MB located in the middle one third of the left anterior descending (LAD) artery and then investigated element accumulation in the LAD artery of the hearts with the MB by direct chemical analysis. Eighty-four formalin-fixed adult Thai hearts were dissected and the MBs were found in 39 of 84 hearts with a total of 44 MBs. The 37 MBs were located in the middle one third of the LAD artery. To examine the action of the MB on element accumulation in the LAD artery, the hearts with the MB which was located in the middle one third of the LAD artery and was longer than 1.5 cm were used as Materials. The left main coronary (LMC) and LAD arteries were removed from these hearts successively and the isolated arteries were divided into eight to ten segments. After incineration of arteries with nitric acid and perchloric acid, seven element contents of Ca, P, S, Mg, Zn, Fe, and Na were determined by inductively coupled plasma-atomic emission spectrometry. To examine the endothelial changes of the LAD artery, the inner surface of segments of the LAD artery was observed by scanning electron microscopy. It was found that the extent of accumulation of Ca, P, Zn, and Na was not uniform throughout the LAD artery and was higher in the proximal part than in the distal part with regard to the LAD artery beneath the MB (the tunneled LAD artery). The extent of accumulation of Ca, P, Zn, and Na in the proximal part of the tunneled LAD artery was similar to that in the segments proximal to the MB, whereas the extent of accumulation of Ca, P, Zn, and Na in the distal part of the tunneled LAD artery was similar to that in the segments distal to the MB. PMID:26343360

  7. Anterior chest wall elevation using a T-fastener suture technique during a Nuss procedure.

    PubMed

    Kim, Daabin; Idowu, Olajire; Palmer, Barnard; Kim, Sunghoon

    2014-08-01

    The most critical part of the Nuss procedure is the passage of the introducer across the anterior mediastinum without cardiac injury. For patients with severe pectus excavatum, passing the introducer can be difficult and hazardous. We describe a technique that resembles a use of T-fastenerlike suture material to elevate the anterior chest. The elevation of the chest allows safe, blunt anterior mediastinal dissection before the passage of the introducer. The risk of intraoperative cardiac perforation is minimized. PMID:25087810

  8. Reversal of segmental hypokinesis by coronary angioplasty in patients with unstable angina, persistent T wave inversion, and left anterior descending coronary artery stenosis. Additional evidence for myocardial stunning in humans

    SciTech Connect

    Renkin, J.; Wijns, W.; Ladha, Z.; Col, J. )

    1990-09-01

    To evaluate the significance of persistent negative T waves during severe ischemia, we prospectively studied 62 patients admitted for unstable angina without evidence of recent or ongoing myocardial infarction. A critical stenosis on the left anterior descending coronary artery (LAD), considered as the culprit lesion, was successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The patients were divided into two groups according to the admission electrocardiogram: T NEG group (n = 32) had persistent negative T waves, and the T POS group (n = 30) had normal positive T waves on precordial leads. The two groups had similar baseline clinical, hemodynamic, and angiographic characteristics. All patients underwent a complete clinical and angiographic evaluation (coronary arteriography and left ventriculography) before undergoing PTCA and 8 +/- 3 months later. Left ventricular anterior wall motion was evaluated by the percent shortening of three areas (S1, S2, and S3) considered as LAD-related segments on left ventriculograms. Before PTCA, there was no significant difference in global ejection fraction between the two groups despite a significant depression in anterior mean percent area shortening in the T NEG compared with the T POS group (S1, 44 versus 54, p less than 0.01; S2, 39 versus 48, p less than 0.01; S3, 44 versus 50, NS). At repeated angiography, the anterior mean percent area shortening improved significantly in the T NEG group (S1, from 44 to 61, p less than 0.001; S2, from 39 to 58, p less than 0.001; S3, from 44 to 61, p less than 0.001).

  9. [Influence of laser -- infrared irradiation on local complications of early postoperative period in hernias of anterior abdominal wall].

    PubMed

    Gasymov, E M

    2005-01-01

    Results of laser-infrared irradiation (LIRI) of postoperative wound after surgical treatment of recurrent hernias of anterior abdominal wall were analyzed. LIRI decreased number of local complications in early postoperative period in patients both with recurrent and primary hernias. The method was more effective for the treatment of local complication in patients with recurrent hernia that is confirmed by reduced of frequency of infiltrates, seromas and suppurations. PMID:16247383

  10. Vaginal Repair of Cystocele with Anterior Wall Mesh via Transobturator Route: Efficacy and Complications with Up to 3-Year Followup

    PubMed Central

    Moore, Robert D.; Miklos, John R.

    2009-01-01

    Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN). Design. Single center retrospective study. Setting. Single center hospital setting and Urogynecology practice in the United States. Patients. 77 women presenting with symptomatic anterior wall prolapse. Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated. Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the ischial spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3–36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion. Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up. PMID:19710939

  11. Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh

    PubMed Central

    Sharifiaghdas, Farzaneh; Mirzaei, Mahboubeh

    2015-01-01

    Purpose To evaluate the medium-term efficacy and safety of transobturator four-arm polypropylene mesh in the treatment of high-stage anterior vaginal wall prolapse and concomitant stress urinary incontinence (SUI). Materials and Methods Between September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stage≥3 anterior vaginal wall prolapse with or without SUI who presented to Labbafinejad Hospital, Teheran, Iran, and underwent anterior vaginal wall repair with polypropylene mesh. Pre- and postoperative evaluation included history; physical examination using the Pelvic Organ Prolapse Quantification system and cough stress test, both before and after reduction of prolapsed structures; Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ); urinalysis and culture; and a postvoid residual assessment. Complications were reported at a mean of 2 years of follow-up. Results A total of 71 patients underwent cystocele repair with the transobturator four-arm polypropylene mesh. Seven of the patients were lost to follow-up. There were no perioperative complications. The anatomical success rate was 87.5%. The subjective success rate was 92.1%. The PFDI and PFIQ were significantly improved after surgery (p<0.001). Among those with the simultaneous complaint of SUI, 82% were cured without any additional procedure. Three patients (4.6%) experienced vaginal mesh extrusion. Two patients (3.1%) reported worsening of dyspareunia after surgery. Conclusions The four arms polypropylene mesh is an effective device for simultaneous correction of anterior vaginal wall prolapse and SUI with a low complication rate at a medium-term follow-up. The majority of the subgroup with concomitant SUI were cured without a second simultaneous procedure. PMID:26682021

  12. Abnormalities of early depolarization in patients with remote anterior myocardial infarction and ventricular septal hypoperfusion. Diagnosis of septal MI by BSM

    SciTech Connect

    Kubota, I.; Yamaki, M.; Ikeda, K.; Yamaguchi, I.; Tonooka, I.; Tsuiki, K.; Yasui, S. )

    1990-10-01

    The authors conducted this study to find the difference in body surface isopotential maps in 46 patients with previous anterior infarction with and without septal involvement. Thallium-201 myocardial-perfusion imaging identified 25 patients with septal infarction (group P) and 21 without (group N). In contrast to group N, group P had a prominent minimum on the anterior chest during the early phases of the QRS. According to the results obtained, the following criteria for identifying patients with septal infarction (group P) were proposed (1). Criterion 1: The absolute value of the voltage of the minimum is equal to or greater than that of the maximum at 5 ms after the onset of the QRS; (2) Criterion 2: During the early portion of the QRS the voltage of the minimum reaches -0.10 mV at the same time or earlier than the maximum reaches 0.10 mV. Both criteria had higher sensitivities (100% and 100%), specificities (71.4% and 90.5%), and predictive accuracies (87.0% and 95.7%) than either Franklead vectorcardiograms or standard 12-lead electrocardiograms in the study population. Thus, body surface isopotential mapping is considered to be useful for the diagnosis of septal involvement in patients with previous anterior myocardial infarction.

  13. Right ventricular free wall dissection as a rupture tract in left ventricular rupture during acute myocardial infarction.

    PubMed

    Takada, Aya; Saito, Kazuyuki; Murai, Tatsuya; Kurosaki, Kunihiko; Kurihara, Katsuyoshi; Hamamatsu, Akihiko

    2015-11-01

    Three rare cases of cardiac rupture with right ventricular wall dissection during acute myocardial infarction (AMI) were reported. The cases comprised 2% among our 148 previously reported postinfarction cardiac ruptures with sudden death. The dissections occurred in hearts with biventricular inferior wall AMI and developed between the superficial layers and the deeper layers of inferior wall of the right ventricle. All had an endocardial tear at the basal septum where it meets the inferior free wall of the left ventricle, and had an epicardial tear on the middle inferior wall of the right ventricle. Based on the evidence of the ages of the thrombi of the rupture tracts, delayed epicardial rupture was found besides that soon after the right ventricular dissection. PMID:26594003

  14. Metabolic Syndrome is Associated With Higher Wall Motion Score and Larger Infarct Size After Acute Myocardial Infarction

    PubMed Central

    Hajsadeghi, Shokoufeh; Chitsazan, Mitra; Chitsazan, Mandana; Haghjoo, Majid; Babaali, Nima; Norouzzadeh, Zahra; Mohsenian, Maryam

    2015-01-01

    Background: Infarct size is an important surrogate end point for early and late mortality after acute myocardial infarction. Despite the high prevalence of metabolic syndrome in patients with atherosclerotic diseases, adequate data are still lacking regarding the extent of myocardial necrosis after acute myocardial infarction in these patients. Objectives: In the present study we aimed to compare myocardial infarction size in patients with metabolic syndrome to those without metabolic syndrome using peak CK-MB and cardiac troponin I (cTnI) at 72 hours after the onset of symptoms. Patients and Methods: One-hundred patients with metabolic syndrome (group I) and 100 control subjects without metabolic syndrome (group II) who experienced acute myocardial infarction were included in the study. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Myocardial infarction size was compared between the two groups of patients using peak CK-MB and cTnI level in 72 hours after the onset of symptoms. Results: Peak CK-MB and cTnI in 72 hours were found to be significantly higher in patients with metabolic syndrome compared with control subjects (both P < 0.001). Patients with metabolic syndrome also had markedly higher wall motion abnormality at 72 hours after the onset of symptoms as assessed by echocardiographically-derived Wall Motion Score Index (WMSI) (P < 0.001). Moreover, statistically significant relationships were found between WMSI and peak CK-MB and also cTnI at 72 hours (Spearman's rho = 0.56, P < 0.001 and Spearman's rho = 0.5, P < 0.001; respectively). However, association between WMSI and left ventricular ejection fraction was insignificant (Spearman's rho = -0.05, P = 0.46). Conclusions: We showed that patients with metabolic syndrome have larger infarct size compared to control subjects. PMID:25789257

  15. Evidence of impaired myocardial perfusion and abnormal left ventricular function during exercise in patients with isolated systolic narrowing of the left anterior descending coronary artery

    SciTech Connect

    Ahmad, M.; Merry, S.L.; Haibach, H.

    1981-11-01

    Seven men ranging in age from 35 to 63 years with a chest pain syndrome and cineangiographically documented systolic narrowing of the left anterior descending coronary artery underwent thallium-201 myocardial scintigraphy and gated cardiac blood pool imaging. Grade II (50 to 75 percent) systolic coronary arterial constriction was present in three patients and grade III constriction (greater than 75 percent) in four. Three of the four patients with grade III constriction had an exercise-induced perfusion abnormality in the thallium-201 scintigram and impaired left ventricular ejection fraction response during exercise. (In two patients the left ventricular ejection fraction did not change and in one patient it decreased.) Each of the three patients with grade II constriction had normal thallium-201 perfusion and a normal increase in ejection fraction during exercise. These data provide evidence of abnormal myocardial perfusion and impaired left ventricular function during exercise in patients with high grade systolic coronary arterial narrowing.

  16. Evidence of impaired myocardial perfusion and abnormal left ventricular function during exercise in patients with isolated systolic narrowing of the left anterior descending coronary artery.

    PubMed

    Ahmad, M; Merry, S L; Haibach, H

    1981-11-01

    Seven men ranging in age from 35 to 63 years with a chest pain syndrome and cineangiographically documented systolic narrowing of the left anterior descending coronary artery underwent thallium-201 myocardial scintigraphy and gated cardiac blood pool imaging. Grade II (50 to 75 percent) systolic coronary arterial constriction was present in three patients and grade III constriction (greater than 75 percent) in four. Three of the four patients with grade III constriction had an exercise-induced perfusion abnormality in the thallium-201 scintigram and impaired left ventricular ejection fraction response during exercise. (In two patients the left ventricular ejection fraction did not change and in one patient it decreased.) Each of the three patients with grade II constriction had normal thallium-201 perfusion and a normal increase in ejection fraction during exercise. These data provide evidence of abnormal myocardial perfusion and impaired left ventricular function during exercise in patients with high grade systolic coronary arterial narrowing. PMID:7304430

  17. Planar positron imaging of rubidium-82 for myocardial infarction: A comparison with thallium-201 and regional wall motion

    SciTech Connect

    Williams, K.A.; Ryan, J.W.; Resnekov, L.; Stark, V.; Peterson, E.L.; Gustafson, G.C.; Martin, W.B.; Freier, P.A.; Harper, P.V. )

    1989-09-01

    Rubidium-82 (Rb-82) is a generator-produced, short half-life (76 seconds) positron emitting potassium analog. Using a mobile gamma camera equipped with a rotating tungsten collimator and high-energy shielding, we examined the use of Rb-82 in the coronary care unit and clinical laboratory for detection of perfusion defects due to myocardial infarction. We studied 31 subjects, 10 patients with acute myocardial infarction, 12 with remote myocardial infarction, and nine controls. Rb-82 images were compared with Tl-201 and regional wall motion for detection of infarct-related arteries. Of the 22 patients with myocardial infarction, 16 were identified with Rb-82 and Tl-201. In nine control subjects, eight were normal with each method. Correlation between Rb-82 and Tl-201 defect scores was excellent. Sensitivity and specificity for infarct-related arteries were similar for Rb-82, Tl-201, and wall motion imaging. Thus planar Rb-82 imaging can detect MI reliably in the coronary care unit and in the clinical laboratory.

  18. INCREASED PULMONARY PRESSURES AND MYOCARDIAL WALL STRESS IN CHILDREN WITH SEVERE MALARIA*

    PubMed Central

    Janka, Jacqueline J.; Koita, Ousmane A.; Traoré, Broulaye; Traoré, Josépha M.; Mzayek, Fawaz; Sachdev, Vandana; Wang, Xunde; Sanogo, Kassoum; Sangaré, Lansana; Mendelsohn, Laurel; Masur, Henry; Kato, Gregory J.; Gladwin, Mark T.; Krogstad, Donald J.

    2011-01-01

    Background Chronic intravascular hemolysis leads to nitric oxide (NO) depletion and pulmonary hypertension in sickle cell disease. To test whether this pathophysiology occurs in malaria, we examined 53 children admitted to hospital with severe malaria (excluding cerebral malaria) and 31 age-matched controls in Mali. Methods Severity of hemolysis was assessed from plasma free hemoglobin (Hb) and arginase-1 levels. NO metabolism was assessed by whole blood nitrite levels and plasma NO consumption. Effects on the cardiovascular system and endothelial function were assessed by using echocardiography to measure peak tricuspid regurgitant jet velocity (TRV) and from plasma levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) and soluble vascular cell adhesion molecule-1 (sVCAM-1). Results Children with severe malaria had higher plasma Hb and arginase-1 levels, reduced whole blood nitrite levels and increased NO consumption relative to controls. They also had increased pulmonary arterial pressures (p < 0.05) with elevated levels of NT-proBNP and sVCAM-1 (p < 0.001). Conclusions Children with severe malaria have increased pulmonary pressures and myocardial wall stress. These complications are consistent with NO depletion from intravascular hemolysis, and indicate that the pathophysiologic cascade from intravascular hemolysis to NO depletion and its cardiopulmonary effects is activated in children with severe malaria. PMID:20662718

  19. Myocardial Bridging.

    PubMed

    Yuan, Shi-Min

    2016-02-01

    Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results. PMID:27074276

  20. Experimental myocardial infarction

    PubMed Central

    Kumar, Raj; Hood, William B.; Joison, Julio; Norman, John C.; Abelmann, Walter H.

    1970-01-01

    Acute myocardial infarction causes depression of left ventricular function, but the capacity of the ventricle to recover from such an injury remains unknown. This problem was explored by measuring left ventricular function in eight intact conscious dogs before, 1 hr after, and again 6-8 days after myocardial infarction. Acute myocardial infarction was produced using a technique which entails gradual inflation over an average period of 1 hr of a balloon cuff previously implanted around the left anterior descending coronary artery. Occurrence of anterior wall infarction was detected electrocardiographically and later confirmed by postmortem examination. Left ventricular function was evaluated from the relationship between left ventricular developed pressure (left ventricular peak systolic pressure minus left ventricular end-diastolic pressure) and left ventricular end-diastolic pressure during transient aortic occlusion with a balloon catheter. Left ventricular function curves were obtained by plotting left ventricular-developed pressure at increasing left ventricular end-diastolic pressures up to 50 mm Hg. Acute myocardial infarction caused marked depression of left ventricular function measured 1 hr after onset of infarction, but 1 wk later all eight animals showed improvement with return of function toward the control levels. A small but significant descending limb was noted at left ventricular end-diastolic pressures above 35 mm Hg. Quantitatively, the descending limb was similar before, 1 hr after, and 1 wk after myocardial infarction. Hemodynamic data revealed evidence of left ventricular failure in all animals, but variability in individual hemodynamic parameters was noted. The data indicate that the marked depression of left ventricular function observed immediately after experimental acute myocardial infarction undergoes considerable resolution within 1 wk, but that functional recovery remains incomplete. PMID:5409808

  1. Wave Propagation of Myocardial Stretch: Correlation with Myocardial Stiffness

    PubMed Central

    Pislaru, Cristina; Pellikka, Patricia A.; Pislaru, Sorin V.

    2015-01-01

    The mechanism of flow propagation during diastole in the left ventricle (LV) has been well described. Little is known about the associated waves propagating along the heart wall s. These waves may have a mechanism similar to pulse wave propagation in arteries. The major goal of the study was to evaluate the effect of myocardial stiffness and preload on this wave transmission. Methods Longitudinal late diastolic deformation and wave speed (Vp) of myocardial stretch in the anterior LV wall were measured using sonomicrometry in sixteen pigs. Animals with normal and altered myocardial stiffness (acute myocardial infarction) were studied with and without preload alterations. Elastic modulus estimated from Vp (EVP; Moens-Korteweg equation) was compared to incremental elastic modulus obtained from exponential end -diastolic stress-strain relation (ESS). Myocardial distensibility and α-and β-coefficients of stress-strain relations were calculated. Results Vp was higher at reperfusion compared to baseline (2.6±1.3 m/s vs. 1.3±0.4 m/s; p=0.005) and best correlated with ESS (r 2=0.80, p<0.0001), β-coefficient (r2=0.78, p<0.0001), distensibility (r2=0.47, p=0.005), and wall thickness/diameter ratio (r2=0.42, p=0.009). Elastic moduli (EVP and ESS) were strongly correlated (r2=0.83, p<0.0001). Increasing preload increased Vp and EVP and decreased distensibility. At multivariate analysis, ESS, wall thickness, and end-diastolic and systolic LV pressures were independent predictors of Vp (r2model=0.83, p<0.0001). Conclusions The main determinants of wave propagation of longitudinal myocardial stretch were myocardial stiffness and LV geometry and pressure. This local wave speed could potentially be measured noninvasively by echocardiography. PMID:25193091

  2. Wave propagation of myocardial stretch: correlation with myocardial stiffness.

    PubMed

    Pislaru, Cristina; Pellikka, Patricia A; Pislaru, Sorin V

    2014-01-01

    The mechanism of flow propagation during diastole in the left ventricle (LV) has been well described. Little is known about the associated waves propagating along the heart walls. These waves may have a mechanism similar to pulse wave propagation in arteries. The major goal of the study was to evaluate the effect of myocardial stiffness and preload on this wave transmission. Longitudinal late diastolic deformation and wave speed (Vp) of myocardial stretch in the anterior LV wall were measured using sonomicrometry in 16 pigs. Animals with normal and altered myocardial stiffness (acute myocardial infarction) were studied with and without preload alterations. Elastic modulus estimated from Vp (E VP; Moens-Korteweg equation) was compared to incremental elastic modulus obtained from exponential end-diastolic stress-strain relation (E SS). Myocardial distensibility and α- and β-coefficients of stress-strain relations were calculated. Vp was higher at reperfusion compared to baseline (2.6 ± 1.3 vs. 1.3 ± 0.4 m/s; p = 0.005) and best correlated with E SS (r2 = 0.80, p < 0.0001), β-coefficient (r2 = 0.78, p < 0.0001), distensibility (r2 = 0.47, p = 0.005), and wall thickness/diameter ratio (r2 = 0.42, p = 0.009). Elastic moduli (E VP and E SS) were strongly correlated (r2 = 0.83, p < 0.0001). Increasing preload increased Vp and E VP and decreased distensibility. At multivariate analysis, E SS, wall thickness, and end-diastolic and systolic LV pressures were independent predictors of Vp (r2 model = 0.83, p < 0.0001). In conclusion, the main determinants of wave propagation of longitudinal myocardial stretch were myocardial stiffness and LV geometry and pressure. This local wave speed could potentially be measured noninvasively by echocardiography. PMID:25193091

  3. Acute Anterior ST-Elevation Myocardial Infarction and Electrical Storm Secondary to Nondominant Right Coronary Artery Occlusion

    PubMed Central

    Brown, Michael; Bashir, Riyaz; O'Murchu, Brian

    2014-01-01

    A 42-year-old man emergently presented with chest pain and anterior ST elevation. Refractory ventricular arrhythmias and shock developed rapidly. A coronary angiogram revealed the acute occlusion of a nondominant right coronary artery. After percutaneous coronary intervention, the anterior ST elevation and ventricular arrhythmias resolved. The electrocardiographic pattern was a result of isolated right ventricular infarction that in turn caused profound electrical and hemodynamic instability. We discuss the cause and pathophysiology of this patient's case, and we recommend that interventional and general cardiologists be aware that anterior ST elevation can be caused by the occlusion of a nondominant right coronary artery. PMID:24955058

  4. Predictive value of indium-111 antimyosin uptake for improvement of left ventricular wall motion after thrombolysis in acute myocardial infarction

    SciTech Connect

    van Vlies, B.; Baas, J.; Visser, C.A.; van Royen, E.; Delemarre, B.J.; Bot, H.; Dunning, A.J.

    1989-07-15

    In 21 patients treated with thrombolysis for acute myocardial infarction (AMI), the degree of myocardial uptake of indium-111 monoclonal antimyosin antibodies injected within 24 hours after onset of AMI was compared with the degree and extent of regional asynergy on admission and discharge, as assessed by 2-dimensional echocardiography. On the first day of AMI, 80 MBq of indium-111 antimyosin was injected and planar images were made 24 hours later. Indium-111 antimyosin uptake was evaluated for count density index (count density of infarct zone/left lung count density) in the left anterior oblique projection, in which the infarction zone was well displayed in all patients. Using 2-dimensional echocardiography, the left ventricle was divided into 13 segments and evaluated for regional asynergy, which was considered severe (akinesia or dyskinesia) or mild (hypokinesia). The extent of regional asynergy was measured by the number of asynergic segments. All 21 patients had severe regional asynergy on admission. Nine of 21 showed only mild regional asynergy on discharge and 12 of 21 had persistent severe regional asynergy in at least 1 segment. The count density index was significantly lower in patients with mild regional asynergy on discharge compared with patients with severe regional asynergy (1.63 +/- 0.27 vs 2.50 +/- 0.42, p less than 0.01).

  5. Texture analysis improves level set segmentation of the anterior abdominal wall

    SciTech Connect

    Xu, Zhoubing; Allen, Wade M.; Baucom, Rebeccah B.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-12-15

    Purpose: The treatment of ventral hernias (VH) has been a challenging problem for medical care. Repair of these hernias is fraught with failure; recurrence rates ranging from 24% to 43% have been reported, even with the use of biocompatible mesh. Currently, computed tomography (CT) is used to guide intervention through expert, but qualitative, clinical judgments, notably, quantitative metrics based on image-processing are not used. The authors propose that image segmentation methods to capture the three-dimensional structure of the abdominal wall and its abnormalities will provide a foundation on which to measure geometric properties of hernias and surrounding tissues and, therefore, to optimize intervention.Methods: In this study with 20 clinically acquired CT scans on postoperative patients, the authors demonstrated a novel approach to geometric classification of the abdominal. The authors’ approach uses a texture analysis based on Gabor filters to extract feature vectors and follows a fuzzy c-means clustering method to estimate voxelwise probability memberships for eight clusters. The memberships estimated from the texture analysis are helpful to identify anatomical structures with inhomogeneous intensities. The membership was used to guide the level set evolution, as well as to derive an initial start close to the abdominal wall.Results: Segmentation results on abdominal walls were both quantitatively and qualitatively validated with surface errors based on manually labeled ground truth. Using texture, mean surface errors for the outer surface of the abdominal wall were less than 2 mm, with 91% of the outer surface less than 5 mm away from the manual tracings; errors were significantly greater (2–5 mm) for methods that did not use the texture.Conclusions: The authors’ approach establishes a baseline for characterizing the abdominal wall for improving VH care. Inherent texture patterns in CT scans are helpful to the tissue classification, and texture analysis can improve the level set segmentation around the abdominal region.

  6. Texture analysis improves level set segmentation of the anterior abdominal wall

    PubMed Central

    Xu, Zhoubing; Allen, Wade M.; Baucom, Rebeccah B.; Poulose, Benjamin K.; Landman, Bennett A.

    2013-01-01

    Purpose: The treatment of ventral hernias (VH) has been a challenging problem for medical care. Repair of these hernias is fraught with failure; recurrence rates ranging from 24% to 43% have been reported, even with the use of biocompatible mesh. Currently, computed tomography (CT) is used to guide intervention through expert, but qualitative, clinical judgments, notably, quantitative metrics based on image-processing are not used. The authors propose that image segmentation methods to capture the three-dimensional structure of the abdominal wall and its abnormalities will provide a foundation on which to measure geometric properties of hernias and surrounding tissues and, therefore, to optimize intervention. Methods: In this study with 20 clinically acquired CT scans on postoperative patients, the authors demonstrated a novel approach to geometric classification of the abdominal. The authors’ approach uses a texture analysis based on Gabor filters to extract feature vectors and follows a fuzzy c-means clustering method to estimate voxelwise probability memberships for eight clusters. The memberships estimated from the texture analysis are helpful to identify anatomical structures with inhomogeneous intensities. The membership was used to guide the level set evolution, as well as to derive an initial start close to the abdominal wall. Results: Segmentation results on abdominal walls were both quantitatively and qualitatively validated with surface errors based on manually labeled ground truth. Using texture, mean surface errors for the outer surface of the abdominal wall were less than 2 mm, with 91% of the outer surface less than 5 mm away from the manual tracings; errors were significantly greater (2–5 mm) for methods that did not use the texture. Conclusions: The authors’ approach establishes a baseline for characterizing the abdominal wall for improving VH care. Inherent texture patterns in CT scans are helpful to the tissue classification, and texture analysis can improve the level set segmentation around the abdominal region. PMID:24320512

  7. Does reduced myocardial efficiency in systemic hypertensive-hypertrophy correlate with increased left-ventricular wall thickness?

    PubMed

    Han, June-Chiew; Barrett, Carolyn J; Taberner, Andrew J; Loiselle, Denis S

    2015-08-01

    Elevated systemic blood pressure, and the attendant development of pathologic left ventricular (LV) hypertrophy, ultimately culminates in heart failure and death. In clinical studies, a reduction of myocardial efficiency has been implicated in systemic hypertensive-hypertrophy. However, it is uncertain whether reduced efficiency correlates with LV wall thickness. Hence, we performed experiments on isolated working hearts of spontaneously hypertensive rats (SHRs)-a widely-used experimental model of human hypertensive-hypertrophy. We contrasted their mechanoenergetic performance with that of Wistar controls at two ages: Adult (9 months) and Aged (post-18 months). The use of animal hearts allowed us to perform experiments over a wide range of afterloads. We found that mechanoenergetic performance (coronary and aortic flows, work output and oxygen consumption) declined with age. The peak efficiency of the Adult SHR was essentially similar to that of Control, but that for the Aged SHR was lower, compared with that of age-matched Wistar rats. All variables, including peak efficiency, obtained from the failing Aged SHR hearts (which also developed right ventricular hypertrophy), were greatly reduced. Our data reveal that peak efficiency of the Aged SHR, upon transitioning from compensated hypertrophy to failure, diminishes sharply, arising from compromised flows-both aortic and coronary. We further show that the reduction of myocardial efficiency in hypertensive-hypertrophy does not correlate with LV wall thickness, but instead is inversely correlated with whole-heart mass. The latter relation may serve as a prognostic and diagnostic tool in the clinical setting. PMID:25787044

  8. A case of a urethral diverticular adenocarcinoma after the fenestration of the anterior vaginal wall for pelvic floor abscess

    PubMed Central

    Watanabe, Ryuta; Sugahara, Takeshi; Hamada, Hitoshi

    2016-01-01

    A 61-year-old woman presented to the gynecology department with complaints of atypical genital bleeding. Magnetic resonance imaging revealed a localized urethral tumor extended to vagina. Histological test of the biopsy tissue of the mass suggested the adenocarcinoma. The patient was performed the fenestration of the anterior vaginal wall 15 years ago. Under the diagnosis of urethral diverticular adenocarcinoma, we performed standard open total cystectomy with lymph node excision and ileal conduit. We could not establish a diagnosis of urethral diverticulum from the histological test; however, we clinically diagnosed as urethral diverticular adenocarcinoma. Because carcinoma arising from urethral diverticula is reported, a close long-term follow-up for the recurrence or generation of malignant tumors by genitourinary examinations or images is necessary, for the patient with urethral diverticula. PMID:26941237

  9. Desmoid Tumor of the Anterior Abdominal Wall in Female Patients: Comparison with Endometriosis

    PubMed Central

    Krentel, H.; Tchartchian, G.; De Wilde, R. L.

    2012-01-01

    In female patients presenting a tumor of the lower abdominal wall especially after cesarian section, an endometriotic tumor as well as an aggressive desmoid tumor should be considered. Symptoms in correlation with the monthly period can facilitate the presurgical differentiation between endometriosis and fibromatosis. Ultrasound reveals the typical location of both tumors and its remarkable sonographic appearance. In the clinical practice, the desmoid fibromatosis of the lower abdominal wall is a very rare disease. We present a case of a 25-year-old pregnant and discuss diagnostic and therapeutic options by a PubMed literature review. With the knowledge of the prognosis of the desmoid fibromatosis and the respective treatment options including wait and see, complete surgical resection with macroscopically free margins and adjuvant approaches is essential to avoid further interventions and progression of the locally destructive tumor. PMID:22778752

  10. Desmoid tumor of the anterior abdominal wall in female patients: comparison with endometriosis.

    PubMed

    Krentel, H; Tchartchian, G; De Wilde, R L

    2012-01-01

    In female patients presenting a tumor of the lower abdominal wall especially after cesarian section, an endometriotic tumor as well as an aggressive desmoid tumor should be considered. Symptoms in correlation with the monthly period can facilitate the presurgical differentiation between endometriosis and fibromatosis. Ultrasound reveals the typical location of both tumors and its remarkable sonographic appearance. In the clinical practice, the desmoid fibromatosis of the lower abdominal wall is a very rare disease. We present a case of a 25-year-old pregnant and discuss diagnostic and therapeutic options by a PubMed literature review. With the knowledge of the prognosis of the desmoid fibromatosis and the respective treatment options including wait and see, complete surgical resection with macroscopically free margins and adjuvant approaches is essential to avoid further interventions and progression of the locally destructive tumor. PMID:22778752

  11. Spontaneous coronary artery dissection presenting as acute myocardial infarction.

    PubMed Central

    Mahenthiran, J.; Revankar, R.; Koka, V.; Hoo, J.; Shenoy, M.

    2000-01-01

    Spontaneous coronary artery dissection is a rare entity being increasingly diagnosed as a cause of acute myocardial infarction, especially in cases of low cardiac risk female patients. This is one such case report of a black female patient, who suffered an acute anterior wall myocardial infarction due to an idiopathic spontaneous coronary artery dissection of the left anterior descending artery. She was treated with a thrombolytic agent in the acute phase, uneventfully. An urgent coronary angiogram demonstrated an intimal tear with a dissection of the left anterior descending artery. She survived the acute event and her subsequent hospital course was uncomplicated. Hence she was treated medically for her ischemic event and left ventricular systolic dysfunction with a favorable outcome. This case is yet another report of a survivor treated with a thrombolytic agent for the acute myocardial infarction due to spontaneous coronary artery dissection. Images Figure 2 Figure 3 PMID:10800297

  12. Giant left anterior descending coronary artery aneurysm in an adult male patient with ST elevation myocardial infarction

    PubMed Central

    Sadeghi, Mohsen Mirmohammad; Jouzdani, Saeid Rezaei

    2016-01-01

    Coronary artery aneurysm is a rare clinical entity encountered incidentally 0.3–5% among patients who undergo coronary angiography. Even giant coronary artery aneurysm is much rarer with an incidence of 0.02% among all atherosclerotic cases. Due to rare occurrence and lack of controlled trials, clinical presentation, prognosis and management of giant coronary artery aneurysm are under controversies in the literature. We report a 43-year-old male patient admitted to our hospital with a typical chest pain associated with ST elevation changes in anterior chest leads and elevated cardiac enzymes. Coronary angiography of the patient revealed a large (1.5 cm × 3 cm) aneurysm of proximal left anterior descending coronary artery. We performed a successful surgical excision and coronary bypass surgery. The patient had an uncomplicated course. PMID:27021297

  13. Left anterior descending coronary artery wall thickness measured by high-frequency transthoracic and epicardial echocardiography includes adventitia.

    PubMed

    Gradus-Pizlo, Irmina; Bigelow, Brian; Mahomed, Yousuf; Sawada, Stephen G; Rieger, Karen; Feigenbaum, Harvey

    2003-01-01

    High-frequency, 2-dimensional transthoracic echocardiography (HR-2DTTE) measurements of the left anterior descending (LAD) coronary artery wall thickness are larger than measurements obtained by intravascular ultrasound. We hypothesize that this difference is due to inclusion of the third vascular layer, which may represent adventitia by HR-2DTTE, and that this layer must be increasing in thickness with the development of atherosclerosis. We evaluated the contribution of this third layer to the wall thickness of the normal and atherosclerotic LAD artery imaged by HR-2DTTE using high-frequency epicardial echocardiography (HFEE) as the reference standard. Eighteen patients (10 men, mean age 62 years), 13 with coronary atherosclerosis and 5 with normal coronary arteries, referred for open-heart surgery, underwent preoperative HR-2DTTE evaluation of the LAD artery (SONOS 5500; 3- to 8-MHz transducer) and intraoperative HFEE of the LAD artery (SONOS 5500; 6- to 15-MHz transducer). Wall thickness was greater in patients with coronary atherosclerosis than in those with normal coronary arteries by both HR-2DTTE (1.9 +/- 0.3 vs 1.0 +/- 0.1 mm, p = <0.001) and HFEE (1.8 +/- 0.2 vs 1.0 +/- 0.2 mm, p = <0.001). On HFEE, the average intima plus media thickness was greater in patients with coronary atherosclerosis than in those with normal coronary arteries (0.78 +/- 0.3 vs 0.34 +/- 0.1 mm, p = 0.005). The average thickness of adventitia was also greater in patients with coronary atherosclerosis than in those with normal coronary arteries (0.92 +/- 0.2 vs 0.54 +/- 0.2 mm, p = 0.0005). HR-2DTTE and HFEE measurements of the wall thickness correlated well (r = 0.83 [reader 1], p <0.001; r = 0.61 [reader 2], p <0.01). A third vascular layer, which likely included adventitia, represents a significant portion of the LAD wall thickness imaged by HR-2DTTE and HFEE, and it significantly increases in thickness with the development of atherosclerosis. PMID:12505567

  14. Electrocardiographic diagnosis of remote posterior wall myocardial infarction using unipolar posterior lead V9

    SciTech Connect

    Rich, M.W.; Imburgia, M.; King, T.R.; Fischer, K.C.; Kovach, K.L. )

    1989-09-01

    The accuracy of four electrocardiographic criteria for diagnosing remote posterior myocardial infarction was assessed prospectively in 369 patients undergoing exercise treadmill testing with thallium scintigraphy. Criteria included the following: (1) R-wave width greater than or equal to 0.04 s and R-wave greater than or equal to S-wave in V1; (2) R-wave greater than or equal to S-wave in V2; (3) T-wave voltage in V2 minus V6 greater than or equal to 0.38 mV (T-wave index); (4) Q-wave greater than or equal to 0.04 s in left paraspinal lead V9. Twenty-seven patients (7.3 percent) met thallium criteria for posterior myocardial infarction, defined as a persistent perfusion defect in the posterobase of the left ventricle. Sensitivities for the four criteria ranged from 4 to 56 percent, and specificities ranged from 64 to 99 percent. Posterior paraspinal lead V9 provided the best overall predictive accuracy (94 percent), positive predictive value (58 percent), and ability to differentiate patients with and without posterior myocardial infarction of any single criterion (p less than .0001). Combining the T-wave index with lead V9 further enhanced the diagnostic yield: the sensitivity for detecting posterior infarction by at least one of these criteria was 78 percent, and when both criteria were positive, specificity was 98.5 percent. It is concluded that a single, unipolar posterior lead in the V9 position is superior to standard 12-lead electrocardiographic criteria in diagnosing remote posterior myocardial infarction, and that combining V9 with the T-wave index maximizes the diagnostic yield.

  15. The Continuity of Right and Left Ventricular Myocardial Sinusoidal Spaces and its Relation to Right Ventricular Implants

    PubMed Central

    Vineberg, Arthur; Syed, A. Kadir

    1970-01-01

    Evidence is presented which indicates that blood leaving side branches of an internal mammary artery implanted into the anterior wall of the right ventricle flows from the tunnel in which it lies through myocardial sinusoidal spaces of the anterior right ventricular wall across the midline to fill corresponding spaces in the anterior wall of the left ventricle and thence is carried to the left coronary sinus. The myocardial sinusoidal spaces of right and left ventricles have been well outlined, using injections of polyvinyl acetate and the technique of digestion casts. We have been able to show that there is no barrier between the myocardial sinusoids of the right circulation and those related to the anterior descending branch of the left coronary artery. In structure, these myocardial sinusoidal spaces are quite different from the intramyocardial coronary arteriolar zones which, in 93% of human hearts, are separated from one another without collateral communication. The continuity of the right and left ventricular myocardial sinusoids explains why implantation of a right internal mammary artery into the anterior wall of the right ventricle combined with a corresponding left implant, epicardiectomy and free omental graft, has been so effective in our hands in the treatment of far-advanced human coronary artery insufficiency. ImagesFIG. 2FIG. 3FIG. 4FIG. 6FIG. 7FIG. 8FIG. 9 PMID:5445044

  16. [A case of rupture of the left ventricle free wall with papillary muscle dysfunction following acute myocardial infarction, operated on successfully].

    PubMed

    de Lima, R; Perdigo, C; Neves, L; Cravino, J; Dantas, M; Bordalo, A; Pais, F; Diogo, A N; Ferreira, R; Ribeiro, C

    1990-09-01

    The authors present a case of left ventricular free wall rupture post acute myocardial infarction, associated with mitral papillary posterior muscle necrosis, operated by infartectomy and mitral valvular protesis replacement. They refer the various complications occurred during the hospital staying, and discuss its medical and surgical approach. The patient was discharged alive and six months after the infarction keeps a moderate activity. PMID:2257157

  17. Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances

    SciTech Connect

    Braat, S.H.; de Zwaan, C.; Brugada, P.; Coenegracht, J.M.; Wellens, H.J.

    1984-06-01

    In 67 consecutive patients with inferior wall acute myocardial infarction (AMI), 99m-technetium pyrophosphate scintigraphy was performed 36 to 72 hours after the onset of chest pain to detect right ventricular (RV) involvement. All patients were continuously monitored during at least 3 days to detect rhythm and conduction disturbances. In 29 patients RV involvement was diagnosed by scintigraphy. None of these 29 patients showed clinical signs of right-sided heart failure. Fourteen of the 19 patients showing atrioventricular (AV) nodal condution disturbances in the setting of inferior AMI also had RV involvement. Therefore, the incidence of high-degree AV nodal block in patients with RV involvement (14 of 29 patients) was 48% compared to only 13% (5 of 38) in patients with inferior AMI without RV involvement.

  18. Extracorporeal bypass preserved composite anterior thigh free flap (periosteo-musculo-fascio-cutaneous) for hemipelvectomy reconstruction: utilizing the periosteal component for abdominal wall fascial reconstruction.

    PubMed

    Newsome, R Edward; Warner, Meredith A; Wilson, Scott C; Sabeeh, Vasif N; Jansen, David A; McKee, Paul R

    2005-03-01

    We present a case of a right external hemipelvectomy for chondroblastic osteosarcoma originating from the right ilium and reconstruction with salvage parts; cardiopulmonary bypass preserved anterior thigh free flap. The resection required sacrifice of the right common iliac artery and vein and the entire right gluteus maximus muscle. The first stage of the procedure was a high above-knee amputation on the ipsilateral leg. The amputated extremity was placed on extracorporeal bypass utilizing the common femoral artery and vein. This technique, previously unreported, supported the successful utilization of the anterior thigh free flap for both soft tissue and abdominal wall facial reconstruction. PMID:15725844

  19. Image-guided intensity-modulated radiotherapy for prostate cancer: Dose constraints for the anterior rectal wall to minimize rectal toxicity

    SciTech Connect

    Peterson, Jennifer L.; Buskirk, Steven J.; Heckman, Michael G.; Diehl, Nancy N.; Bernard, Johnny R.; Tzou, Katherine S.; Casale, Henry E.; Bellefontaine, Louis P.; Serago, Christopher; Kim, Siyong; Vallow, Laura A.; Daugherty, Larry C.; Ko, Stephen J.

    2014-04-01

    Rectal adverse events (AEs) are a major concern with definitive radiotherapy (RT) treatment for prostate cancer. The anterior rectal wall is at the greatest risk of injury as it lies closest to the target volume and receives the highest dose of RT. This study evaluated the absolute volume of anterior rectal wall receiving a high dose to identify potential ideal dose constraints that can minimize rectal AEs. A total of 111 consecutive patients with Stage T1c to T3a N0 M0 prostate cancer who underwent image-guided intensity-modulated RT at our institution were included. AEs were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. The volume of anterior rectal wall receiving 5 to 80 Gy in 2.5-Gy increments was determined. Multivariable Cox regression models were used to identify cut points in these volumes that led to an increased risk of early and late rectal AEs. Early AEs occurred in most patients (88%); however, relatively few of them (13%) were grade ≥2. At 5 years, the cumulative incidence of late rectal AEs was 37%, with only 5% being grade ≥2. For almost all RT doses, we identified a threshold of irradiated absolute volume of anterior rectal wall above which there was at least a trend toward a significantly higher rate of AEs. Most strikingly, patients with more than 1.29, 0.73, or 0.45 cm{sup 3} of anterior rectal wall exposed to radiation doses of 67.5, 70, or 72.5 Gy, respectively, had a significantly increased risk of late AEs (relative risks [RR]: 2.18 to 2.72; p ≤ 0.041) and of grade ≥ 2 early AEs (RR: 6.36 to 6.48; p = 0.004). Our study provides evidence that definitive image-guided intensity-modulated radiotherapy (IG-IMRT) for prostate cancer is well tolerated and also identifies dose thresholds for the absolute volume of anterior rectal wall above which patients are at greater risk of early and late complications.

  20. Radionuclide imaging of myocardial infarction using Tc-99m TBI

    SciTech Connect

    Holman, B.L.; Campbell, S.; Kirshenbaum, J.M.; Lister-James, J.; Jones, A.G.; Davison, A.; Antman, E.

    1985-05-01

    The cationic complex Tc-99m t-butylisonitrile (TBI) concentrates in the myocardial tissue of several animal species. Its myocardial distribution is proportional to blood flow both in zones of ischemia and in normal myocardium at rest. Planar, tomographic, and gated myocardial images have been obtained using Tc-99m TBI in the human. The authors investigated the potential application of Tc-99m TBI imaging to detect and localize myocardial infarction. Four subjects without clinical evidence of cardiovascular disease and five patients with ECG evidence of previous myocardial infarction were studied. Tc-99m TBI (10mCi) was injected intravenously with the patient in a resting state with planar imaging in the anterior, 30 and 70 degree LAO projections beginning one hr after injection. The distribution of the tracer was homogeneous throughout the left ventricular wall in the normal subjects. Regional perfusion defects were present in 4/5 of the patients with myocardial infarction. Location of the defects corresponded to the location of the infarct using ECG criteria (2 inferoposterior and 2 anterior). The patient in whom the Tc-99m TBI image appeared normal had sustained a subendocardial myocardial infarct which could not be localized by ECG; the other 4 pts had transmural infarcts. Anterior and 30 degree LAO images were of excellent quality in all cases; there was overlap of the liver on the inferior wall of the left ventricle on the 70 degree LAO views. The authors conclude that accurate perfusion imaging may be possible using Tc-99m TBI in patients with transmural myocardial infarction.

  1. Peeling off the Mask: Pseudo Myocardial Infarction Pattern on Electrocardiogram During AICD Implantation

    PubMed Central

    Kumar, Sudeep; Kapoor, Aditya; Moorthy, Nagaraja; Lokhandwala, Yash

    2016-01-01

    Lead induced transient right bundle branch block is not uncommon during pacemaker implantation. We describe a patient with old anterior wall myocardial infarction with severe left ventricular dysfunction presenting with recurrent ventricular tachycardia who developed transient right bundle branch block and pseudomyocardial infacrction pattern during AICD implantation.

  2. Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging

    PubMed Central

    Woo, Jong Shin; Yu, Tae-Kyung; Kim, Woo-Shik; Kim, Kwon Sam; Kim, Weon

    2015-01-01

    Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction (AMI) is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging (2D-STI) in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention (PCI) in 30 patients with AMI, who had a left anterior descending coronary artery (LAD) culprit lesion. In addition, 20 patients who had minimal stenotic lesions (< 30% stenosis) on coronary angiography were also included in the control group. At six months dobutamine echocardiography was performed for viability assessment in seven segments of the LAD territory. According to the recovery of wall motion abnormality, segments were classified as viable or non-viable. Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability (hazard ratio: 31.22, P < 0.01). Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI. PMID:26512237

  3. Thallium-201/technetium-99m pyrophosphate overlap in patients with acute myocardial infarction after thrombolysis: prediction of depressed wall motion despite thallium uptake

    SciTech Connect

    Schofer, J.; Spielmann, R.P.; Broemel, T.B.; Bleifeld, W.; Mathey, D.G.

    1986-08-01

    Intracoronary thallium-201/technetium-99m pyrophosphate planar scintigraphy was performed in 60 patients with acute myocardial infarction undergoing intracoronary thrombolysis to predict salvage of myocardium immediately after thrombolysis. In eight patients a significant overlap of new thallium uptake and technetium pyrophosphate accumulation was found after thrombolysis. Intravenous planar thallium scintigraphy revealed thallium uptake in the region of overlap in all patients; circumferential profile analysis showed no difference in the thallium scintigrams before and after technetium injections. Both findings indicate that overlap is not the result of scattering of technetium into the thallium window. Emission computed tomography revealed thallium/technetium pyrophosphate uptake in identical slices and regions. Regional wall motion in the area of overlap remained depressed in all patients, in contrast to patients with similar thallium uptake without overlap. These data suggest that thallium/technetium pyrophosphate overlap reflects the close proximity of viable and necrotic myocardial cells and predicts depressed wall motion after thrombolysis.

  4. Severe thrombocytopenia soon after drug-eluting stent implantation in ST-elevation myocardial infarction.

    PubMed

    Łebek-Szatańska, Agnieszka; Pośnik-Kisło, Anna; Błaszak-Ciećwierska, Wiesława; Dąbrowski, Marek

    2015-01-01

    Thrombocytopenia is among the most frequent haematological issues in patients hospitalised with myocardial infarction. We discuss the case of a 77-year-old male who was admitted to hospital on the 4(th) hour of ST-elevation myocardial infarction of the anterior wall. A percutaneous coronary intervention to critically stenoted initial segment of the anterior descending branch was performed. A few days later he started developing symptomatic thrombocytopenia. On the course of his long hospitalization we faced many important problems, concerning both diagnosis and treatment of these co-existing conditions. PMID:26677393

  5. Myocardial metabolism, perfusion, wall motion and electrical activity in Duchenne muscular dystrophy

    SciTech Connect

    Perloff, J.K.; Henze, E.; Schelbert, H.R.

    1982-01-01

    The cardiomyopathy of Duchenne's muscular dystrophy originates in the posterobasal left ventricle and extends chiefly to the contiguous lateral wall. Ultrastructural abnormalities in these regions precede connective tissue replacement. We postulated that a metabolic fault coincided with or antedated the subcellular abnormality. Accordingly, regional left ventricular metabolism, perfusion and wall motion were studied using positron computed tomography and metabolic isotopes supplemented by thallium perfusion scans, equilibrium radionuclide angiography and M-mode and two-dimensional echocardiography. To complete the assessment, electrocardiograms, vectorcardiograms, 24 hour taped electrocardiograms and chest x-rays were analyzed. Positron computed tomography utilizing F-18 2-fluoro 2-deoxyglucose (FDG) provided the first conclusive evidence supporting the hypothesis of a premorphologic regional metabolic fault. Thus, cardiac involvement in duchenne dystrophy emerges as a unique form of heart disease, genetically targeting specific regions of ventricular myocardium for initial metabolic and subcellular changes. Reported ultrastructural abnormalities of the impulse and conduction systems provide, at least in part, a basis for the clinically observed sinus node, intraatrial, internodal, AV nodal and infranodal disorders.

  6. Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer

    SciTech Connect

    Tan Wenyong; Liu Dong; Xue Chenbin; Xu Jiaozhen; Li Beihui; Chen Zhengwang; Hu Desheng; Wang Xionghong

    2012-04-01

    Purpose: We investigated whether the heart could be replaced by the anterior myocardial territory (AMT) as the organ at risk (OAR) in intensity-modulated radiotherapy (IMRT) of the breast for patients with left-sided breast cancer. Methods and Materials: Twenty-three patients with left-sided breast cancer who received postoperative radiation after breast-conserving surgery were studied. For each patient, we generated five IMRT plans including heart (H), left ventricle (LV), AMT, LV+AMT, and H+LV as the primary OARs, respectively, except both lungs and right breast, which corresponded to IMRT(H), IMRT(LV), IMRT(AMT), IMRT(LV+AMT), and IMRT(H+LV). For the planning target volumes and OARs, the parameters of dose-volume histograms were compared. Results: The homogeneity index, conformity index, and coverage index were not compromised significantly in IMRT(AMT), IMRT(LV) and IMRT(LV+ AMT), respectively, when compared with IMRT(H). The mean dose to the heart, LV, and AMT decreased 5.3-21.5% (p < 0.05), 19.9-29.5% (p < 0.05), and 13.3-24.5% (p < 0.05), respectively. Similarly, the low (e.g., V5%), middle (e.g., V20%), and high (e.g., V30%) dose-volume of the heart, LV, and AMT decreased with different levels. The mean dose and V10% of the right lung increased by 9.2% (p < 0.05) and 27.6% (p < 0.05), respectively, in IMRT(LV), and the mean dose and V5% of the right breast decreased significantly in IMRT(AMT) and IMRT(LV+AMT). IMRT(AMT) was the preferred plan and was then compared with IMRT(H+LV); the majority of dose-volume histogram parameters of OARs including the heart, LV, AMT, both lungs, and the right breast were not statistically different. However, the low dose-volume of LV increased and the middle dose-volume decreased significantly (p < 0.05) in IMRT(AMT). Also, those of the right lung (V10%, V15%) and right breast (V5%, V10%) decreased significantly (p < 0.05). Conclusions: The AMT may replace the heart as the OAR in left-sided breast IMRT after breast-conserving surgery to decrease the radiation dose to the heart.

  7. Relation of global and regional left ventricular function to tomographic thallium-201 myocardial perfusion in patients with prior myocardial infarction

    SciTech Connect

    Stratton, J.R.; Speck, S.M.; Caldwell, J.H.; Martin, G.V.; Cerqueira, M.; Maynard, C.; Davis, K.B.; Kennedy, J.W.; Ritchie, J.L.

    1988-07-01

    To determine the relation between regional myocardial perfusion and regional wall motion in humans, tomographic thallium-201 imaging and two-dimensional echocardiography at rest were performed on the same day in 83 patients 4 to 12 weeks after myocardial infarction. Myocardial perfusion and wall motion were assessed independently in five left ventricular regions (total 415 regions). Regional myocardial perfusion was quantitated as a percent of the region infarcted (range 0 to 100%) using a previously validated method. Wall motion was graded on a four point scale as 1 = normal (n = 266 regions), 2 = hypokinesia (n = 64), 3 = akinesia (n = 70), 4 = dyskinesia (n = 13) or not evaluable (n = 2). Regional wall motion correlated directly with the severity of the perfusion deficit (r = 0.68, p less than 0.0001). Among normally contracting regions, the mean perfusion defect score was only 2 +/- 4. Increasingly severe wall motion abnormalities were associated with larger perfusion defect scores (hypokinesia = 6 +/- 5, akinesia = 11 +/- 7 and dyskinesia = 18 +/- 5, all p less than 0.01 versus normal. Among regions with normal wall motion, only 3% had a perfusion defect score greater than or equal to 10. Conversely, among 68 regions with a large (greater than or equal to 10) perfusion defect, only 13% had normal motion whereas 87% had abnormal wall motion. The relation between perfusion and wall motion noted for the entire cohort was also present in subgroups of patients with anterior or inferior infarction. In patients with prior myocardial infarction, the severity of the tomographic thallium perfusion defect correlates directly with echocardiographically defined wall motion abnormalities, both globally and regionally.

  8. Delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure.

    PubMed

    Tsai, Tsung-Neng; Yang, Shih-Ping; Tsao, Tien-Ping; Huang, Kuo-An; Cheng, Shu-Meng

    2005-11-01

    A 53-year-old man experienced persistent chest pain followed by slight shortness of breath after being hit in the chest by a stranger. Chest X-ray study showed no rib fractures but electrocardiography indicated acute anterior wall myocardial infarction. Echocardiography revealed akinesia in both the interventricular septum and anterior left ventricular wall. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending coronary artery, 9 h after the event. He was successfully treated with coronary angioplasty and stenting procedures. However, poor left ventricular function was observed 3 months after the event despite medications. We conclude that evaluation for possible myocardial injury should be considered soon after blunt chest trauma for early treatment to improve prognosis. PMID:16243201

  9. Resolution of airflow obstruction on polysomnography after laryngotracheal reconstruction with anterior tracheal wall suspension in a patient with DiGeorge Syndrome.

    PubMed

    Jon, Cindy; Mitchell, Sarah E; Mosquera, Ricardo A; Stark, James M; Yuksel, Sancak

    2014-10-01

    DiGeorge Syndrome (DGS) may be associated with airway abnormalities including laryngomalacia and suprastomal collapse of the trachea (SCT), which may lead to sleep disordered breathing (SDB). We present a 4-year-old boy with DGS, SCT, and SDB by polysomnography (PSG) while the tracheostomy tube was capped. The patient underwent anterior tracheal wall suspension (ATWS) with concurrent tracheostomy decannulation. Following the repair, the patient experienced improved airway patency visually and by PSG with resolution of obstructive sleep apnea and hypoventilation. ATWS is an effective method to repair SCT in selected patients and may lead to early decannulation and improvement of SDB. PMID:25129846

  10. Cardiac magnetic resonance detection and typical appearance of microvascular obstruction following myocardial infarction.

    PubMed

    Karatzis, Emmanouil N; Pipilis, Athanassios G; Malios, Konstantinos; Andreou, John; Roussakis, Arkadios; Tsertos, Fotios; Danias, Peter G

    2009-01-01

    We report the case of a 58-year-old man with a recent anterior myocardial infarction, for which he did not receive prompt reperfusion therapy. The patient underwent cardiac magnetic resonance (CMR) imaging, for the assessment of left ventricular function and myocardial viability, and coronary angiography, two weeks after the acute cardiac event. The CMR study demonstrated a moderately dilated left ventricle, with impaired systolic function and wall motion abnormalities in the anterior, apical and inferior left ventricular walls. The T1-weighted images obtained early after contrast administration demonstrated a dark rim in the endocardial region of the interventricular septum and apex. The delayed-enhanced images demonstrated complete absence of signal at the same rim, adjacent to a hyper-enhanced region that corresponded to the wall motion abnormalities. These findings are suggestive of microvascular obstruction in the distribution of the left anterior descending coronary artery. Microvascular obstruction has been reported to correlate positively with the size of the infarction and the left ventricular end-diastolic volume, and inversely with the left ventricular ejection fraction. Furthermore, it has been reported as an independent predictor of future major cardiovascular events. Microvascular obstruction should be routinely checked for in patients presenting in the peri-myocardial infarction period for CMR assessment of myocardial viability. PMID:19329419

  11. The association of increased stomach wall radiotracer uptake with prolonged use of omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT.

    PubMed

    Javadi, Hamid; Jallalat, Sara; Semnani, Shahriar; Mogharrabi, Mehdi; Nabipour, Iraj; Tabib, Seyed Masoud; Abbaszadeh, Moloud; Assadi, Majid

    2013-01-01

    Myocardial perfusion imaging (MPI) is widely used in routine practice for diagnosis and risk stratification of coronary artery disease (CAD). Intense curvilinear activity in the stomach wall of a patient was seen on MPI raw data. This phenomenon was completely dissimilar to the familiar intraluminal gastric reflux of sestamibi. This observed activity could have resulted in false-positive or false-negative artifacts - and inaccurate diagnosis - of the inferior wall of the left ventricle after MPI processing. On further exploration, the current researchers found that the patient had a history of 10-year Omeprazole capsule consumption. The authors present this infrequent case of intense stomach uptake to stress the related clinical and diagnostic implications with the aim to stimulate acute awareness of possible, unexpected infringements on image quality that could potentially interfere with accurate interpretation of the data. PMID:24068640

  12. Early-phase myocardial infarction: Evaluation by MR imaging

    SciTech Connect

    Tscholakoff, D.; Higgins, C.B.; McNamara, M.T.; Derugin, N.

    1986-06-01

    In vivo gated magnetic resonance (MR) imaging was performed in 12 dogs immediately after occlusion of the left anterior descending coronary artery and serially up to 5 hours and again between 4 and 14 days. This was done to evaluate the appearance of acute myocardial infarcts and to determine how soon after coronary artery occlusion MR imaging can demonstrate the site of acute myocardial ischemia. In nine dogs with postmortem evidence of myocardial infarction, regional increase of signal intensity of the myocardium was present by 3 hours after coronary occlusion and conformed to the site of myocardial infarct found at autopsy. The signal intensity on T2-weighted images of the infarcted on T2-weighted images of the infarcted myocardium was significantly greater than that of normal myocardium at 3, 4, and 5 hours after occlusion. The T2 (spin-spin) relaxation time was significantly prolonged in the region of myocardial infarct at 3, 4, and 5 hours post-occlusion compared with normal myocardium. Myocardial wall thinning and increased intracavitary flow signal were found in six dogs with comparable pre- and postocclusion images in late systole.

  13. ACS, myocardial bridging, Tako-tsubo syndrome and mitral regurgitation

    PubMed Central

    Michels, R.; Brueren, G.; van Dantzig, J.-M.; Pijls, N.; Peels, C.H.; Post, H.

    2005-01-01

    Isolated systolic compression of the mid portion of the left anterior descending artery (LAD) by a bridge of overlying cardiac muscle is an infrequent but well-recognised angiographic anomaly that is often considered harmless. The long-term prognosis appears to be excellent, but occasional reports of patients with angina pectoris, myocardial infarction and sudden death indicate that this is not always true. The prevalence of the anomaly in the normal population is unknown, but the incidence is low and ischaemic events are rare. Tako-tsubo-like left ventricular dysfunction syndrome (TTS) is characterised by ischaemia, anterior ST-segment elevation, no significant coronary artery disease and reversible ampulla-like left ventricular ballooning in postmenopausal females after emotional or physical stress. Dynamic left ventricular outflow tract (LVOT) obstruction is a rare but potentially fatal complication of acute anterior wall infarction. We present a patient with an acute coronary syndrome (ACS) with ST-segment elevation in the anterior leads, transient TTS and transient LVOT obstruction with systolic anterior motion (SAM) of the mitral valve and severe mitral regurgitation. This is the first report of myocardial bridging associated with TTS, and the first report of TTS associated with dynamic LVOT obstruction with SAM and mitral regurgitation. ImagesFigure 2Figure 3 PMID:25696451

  14. Biphasic thallium 201 SPECT-imaging for the noninvasive diagnosis of myocardial perfusion abnormalities in a child with Kawasaki disease--a case report

    SciTech Connect

    Hausdorf, G.; Nienaber, C.A.; Spielman, R.P.

    1988-02-01

    The mucocutaneous lymph node syndrome (Kawasaki disease) is of increasing importance for the pediatric cardiologist, for coronary aneurysms with the potential of thrombosis and subsequent stenosis can develop in the course of the disease. The authors report a 2 1/2-year-old female child in whom, fourteen months after the acute phase of Kawasaki disease, myocardial infarction occurred. Biphasic thallium 201 SPECT-imaging using dipyridamole depicted anterior wall ischemia and inferolateral infarction. This case demonstrates that noninvasive vasodilation-redistribution thallium 201 SPECT-imaging has the potential to predict reversible myocardial perfusion defects and myocardial necrosis, even in small infants with Kawasaki disease.

  15. [Perioperative diagnosis of acute myocardial ischemia].

    PubMed

    Hopf, H B; Tarnow, J

    1992-09-01

    The prevalence of coronary artery disease substantially affects both cardiac and noncardiac surgery. Assuming that biometric data reported from North America are representative for Germany, the following incidences can be estimated: around 1 million out of 8 million patients operated upon each year will suffer from coronary artery disease, and 15,000 of these patients will have a perioperative myocardial infarction. Since a close relationship has been shown between pre-, intra-, and postoperative myocardial ischaemia and postoperative cardiac morbidity and mortality, early diagnosis and therapy of acute perioperative myocardial ischaemia is warranted. The purpose of this review is to weigh critically the various methods for diagnosis of myocardial ischaemia in view of their practicability and cost/benefit relationship in the perioperative setting. The symptoms of angina pectoris are unreliable in the perioperative period, since patients are premedicated preoperatively, without symptoms during anaesthesia, and usually receive analgesics postoperatively. Intraoperative detection of myocardial ischaemia focuses on standard electrocardiography (ECG) with on-line registration of the ST-segment in two leads (usually leads II and V5) and automatic analysis of ST-segment deviation, achieving a sensitivity of 80% in the detection of myocardial ischaemia. Measurement of regional wall motion abnormalities with trans-esophageal echocardiography (TEE) is a more sensitive method of myocardial ischaemia detection compared to ECG. However, several reasons preclude the broader application of this method in the perioperative phase: (1) it lacks validation by an accepted and independent gold standard; (2) there is a wide spectrum of false-positive findings (considerable interindividual variations in left ventricular contraction, bundle branch blocks, hypertension, hypervolemia); (3) changes in the inferior and apical segments of the left ventricle cannot be detected by single-plane TOE. Detection in these segments might be achieved with biplane echocardiography, but few data on this improved technique are presently available; (4) the method is semi-invasive and might be not applicable during periods with a high incidence of myocardial ischaemia, e.g., intubation, the end of anaesthesia, and extubation; (5) anaesthetists seldom fulfil standard guidelines in echocardiography training; and (6) the method is expensive, which also limits its broader application. Cardiokymography, a noninvasive technique, allows analog representation of anterior wall motion.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1416005

  16. Relation of left ventricular perfusion and wall motion with metabolic activity in persistent defects on thallium-201 tomography in healed myocardial infarction

    SciTech Connect

    Tamaki, N.; Yonekura, Y.; Yamashita, K.; Senda, M.; Saji, H.; Hashimoto, T.; Fudo, T.; Kambara, H.; Kawai, C.; Ban, T.

    1988-08-01

    Myocardial viability in persistent thallium (TI)-201 defect is a controversial subject. To assess metabolic activity in segments with persistent defect, stress TI-201 tomography and positron emission tomography using nitrogen-13 ammonia and fluorine-18 2-fluoro-deoxyglucose (FDG) were performed in 28 patients with healed myocardial infarction. The segments with TI-201 perfusion defect in electrocardiogram-determined infarcted areas were selected for assessment. Stress perfusion defect was detected in 61 segments by TI-201 tomography. Twenty-two patients (36%) showed transient defects with redistribution (group 1) and 39 showed persistent defects (group 2). Increase in FDG uptake was observed in 95% in group 1. Among group 2 patients, 15 segments (38%) showed an increase in FDG uptake (group 2A) while the remaining 24 (62%) did not have an increased uptake (group 2B). The decrease in nitrogen-13 ammonia perfusion was more severe in group 2B (-23 +/- 7%) than in group 2A (-13 +/- 9%) (p less than 0.005) and group 1 (-10 +/- 4%) (p less than 0.001). In addition, wall motion scores tended to be lower in group 2B (0.21 +/- 0.71), compared with group 2A (0.67 +/- 0.70) (p = 0.05) and group 1 (0.77 +/- 0.60) (p less than 0.01). These data indicate that metabolic viability was observed in approximately 40% of the segments with persistent TI-201 defect. Preservation of regional perfusion and wall motion in these areas was similar to that in areas with transient TI-201 defect.

  17. Peritoneal fluid causing inferior attenuation on SPECT thallium-201 myocardial imaging in women

    SciTech Connect

    Rab, S.T.; Alazraki, N.P.; Guertler-Krawczynska, E.

    1988-11-01

    On SPECT thallium images, myocardial left ventricular (LV) anterior wall attenuation due to breast tissue is common in women. In contrast, in men, inferior wall counts are normally decreased compared to anterior counts. The purpose of this report is to describe cases of inferior wall attenuation of counts in women caused by peritoneal fluid, not myocardial disease. Twelve consecutive SPECT thallium myocardial studies performed in women on peritoneal dialysis, being evaluated for kidney transplant, were included in this study. For all studies, 3.5 mCi 201Tl were injected intravenously. Thirty-two images were acquired over 180 degrees (45 degrees RAO progressing to 45 degrees LPO) at 40 sec per stop. SPECT images were reviewed in short axis, horizontal long and vertical long axes. Data were also displayed in bullseye format with quantitative comparison to gender-matched normal files. Ten of 12 female patients studied had inferior wall defects on images, confirmed by bullseye display. All patients had approximately 2 liters of peritoneal fluid. Review of planar rotational views showed diaphragm elevation and fluid margin attenuations affecting left ventricular inferior wall. Thus, peritoneal fluid is a cause of inferior attenuation on 201Tl cardiac imaging.

  18. SU-E-J-93: Parametrisation of Dose to the Mucosa of the Anterior Rectal Wall in Transrectal Ultrasound Guided High-Dose-Rate Brachytherapy of the Prostate

    SciTech Connect

    Aitkenhead, A; Hamlett, L; Wood, D; Choudhury, A

    2014-06-01

    Purpose: In high-dose-rate (HDR) brachytherapy of the prostate, radiation is delivered from a number of radioactive sources which are inserted via catheter into the target volume. The rectal mucosa also receives dose during the treatment, which may lead to late toxicity effects. To allow possible links between rectal dose and toxicity to be investigated, suitable methods of parametrising the rectal dose are needed. Methods: During treatment of a series of 95 patients, anatomy and catheter locations were monitored by transrectal ultrasound, and target volume positions were contoured on the ultrasound scan by the therapist. The anterior rectal mucosal wall was identified by contouring the transrectal ultrasound balloon within the ultrasound scan. Source positions and dwell times, along with the dose delivered to the patient were computed using the Oncentra Prostate treatment planning system (TPS). Data for the series of patients were exported from the TPS in Dicom format, and a series of parametrisation methods were developed in a Matlab environment to assess the rectal dose. Results: Contours of the anterior rectal mucosa were voxelised within Matlab to allow the dose to the rectal mucosa to be analysed directly from the 3D dose grid. Dose parametrisations based on dose-surface (DSH) and dose-line (DLH) histograms were obtained. Both lateral and longitudinal extents of the mucosal dose were parametrised using dose-line histograms in the relevant directions. Conclusion: We have developed a series of dose parametrisations for quantifying the dose to the rectal mucosa during HDR prostate brachytherapy which are suitable for future studies investigating potential associations between mucosal dose and late toxicity effects. The geometry of the transrectal probe standardises the rectal anatomy, making this treatment technique particularly suited to studies of this nature.

  19. Relation between the location of the infarcted area in body surface isopotential mapping and the location of myocardial infarction in vectorcardiography

    SciTech Connect

    Suzuki, K.; Toyama, S.; Yoshino, K.; Fudemoto, Y.

    1984-01-01

    In order to examine whether our method of determining the location of the infarcted area in body surface isopotential mapping (MAP) is adequate for clinical use, a comparison was made between the location of the infarcted area using MAP and the location of myocardial infarction using vectorcardiography (VCG). The percentage of agreement between MAP and VCG in the retrospective study was 91.7% in the anterior wall, 76.7% in the lateral wall, 93.3% in the inferior wall and 73.3% in the posterior wall. The reason for the disagreement between these two methods was investigated, and criteria for determining the infarcted area using MAP and vectorcardiographic criteria for myocardial infarction were partly corrected in anterior, lateral and (high) posterior infarction to increase the clinical accuracy of both methods. Consequently, the percentage of agreement in the four walls ranged from 83.7% to 87.9%, and the diagnostic value of MAP for the infarcted area was not inferior but was more sensitive than that of VCG except in anterior infarction. In the prospective study, the same result was obtained. Secondly, in order to establish the superiority of MAP or VCG, the sensitivity and specificity of MAP and VCG to SCG (thallium-201) were calculated. Except in the anterior wall, the sensitivity of MAP to SCG was higher than that of VCG to SCG, especially in the lateral and posterior walls. Accordingly, it is suggested that MAP is the method of choice in determining the infarcted area in clinical cases.

  20. Visualization of right atrial appendix by Thallium-201 myocardial scintigraphy: concise communication

    SciTech Connect

    Adachi, H.; Torii, Y.; Kamide, T.; Katsume, H.; Ochiai, M.; Ijichi, H.

    1980-10-01

    The atrial myocardium has been barely visible with thallium-201 myocardial scintigraphy. This is probably related to the difference in size, distance from anterior chest wall, and small coronary blood flow of the atrium, compared with the ventricle. We have encountered eight cases of visualization of the right atrial appendix (RAA). The RAA was identified from multiple projections in all cases and sometimes confirmed by radionuclide angiocardiography. Evidence derived from ECG, chest radiographs, and cardiac catheterization, indicated that the most important factor in the visualization might be the displacement of the RAA to a more anterior position.

  1. Salmonella Abscess of the Anterior Chest Wall in a Patient With Type 2 Diabetes and Poor Glycemic Control: A Case Report.

    PubMed

    Chiao, Hao-Yu; Wang, Chi-Yu; Wang, Chih-Hsin

    2016-03-01

    Salmonella can cause extra-intestinal focal infections as well as gastrointestinal problems. A few cases of Salmonella skin and soft tissue infection have been documented in immunocompromised patients such as persons with type 2 diabetes and poor glycemic control. A case study is presented of a 30-year-old man with a 10-year history of poorly controlled (HbA1C 11.7%) diabetes mellitus who presented with a ruptured nodule resulting in a wound with signs of infection over his anterior chest region of 1-month duration. He had been taking amoxycillin/clavulanate for the week previous to presentation at the authors' facility. Following sharp debridement, the ulcerative wound deteriorated and a chest wall abscess developed. Bacterial culture results were positive for Salmonella group D, resistant to ampicillin and susceptible to ceftriaxone and ciprofloxacin. The patient underwent surgical debridement, resulting in a wound 7 cm x 4 cm, and was provided ceftriaxone 2.0 g intravenously daily along with insulin therapy. After surgical debridement, a local rotational flap was created for wound closure and reconstruction. The patient was discharged 1 week later on oral antibiotic therapy for 1 week. His wound was completely healed without recurrence at his 4-month follow-up. For this patient, addressing glycemic issues, identifying the infectious organism, and providing appropriate therapy, radical debridement, and flap surgery helped heal an advanced soft tissue infection. In immunocompromised patients with skin or soft tissue infections, the presence of Salmonella should be considered. PMID:26978859

  2. Transient disappearance of Q waves of previous myocardial infarction due to exercise-induced ischemia of the contralateral noninfarcted myocardium.

    PubMed

    Madias, J E; Manyam, B; Khan, M; Singh, V; Tziros, C

    1997-04-01

    The electrocardiogram (ECG) of a 40-year-old woman with an old inferolateral myocardial infarction revealed, in the course of an exercise treadmill/thallium test, gradual disappearance of infarctional Q waves, which reappeared gradually during recovery from exercise. The patient had evidence of exercise-induced myocardial ischemia both by the ECG and by thallium-201 perfusion scintigraphy involving several myocardial regions. The temporal association of transient disappearance of Q waves with the occurrence of reversible ischemia suggested that the latter was instrumental in producing this phenomenon, through a transient failure of the ischemic anterior wall to shift the initial depolarization forces away from the infarcted inferolateral territory. Further evidence for this concept was provided by the case of another patient, a 49-year-old man who also had an old inferolateral myocardial infarction and whose ECG in the course of an exercise treadmill/thallium test did not reveal any changes in the infarctional Q waves. In this patient, thallium images showed mild, reversible inferolateral myocardial ischemia but a well perfused anterior wall, which provided for early depolarization forces (thus Q waves) directed opposite to the region of infarcted myocardium. PMID:9141603

  3. Precordial ST segment depression during acute inferior myocardial infarction: early thallium-201 scintigraphic evidence of adjacent posterolateral or inferoseptal involvement

    SciTech Connect

    Lew, A.S.; Weiss, A.T.; Shah, P.K.; Maddahi, J.; Peter, T.; Ganz, W.; Swan, H.J.; Berman, D.S.

    1985-02-01

    To investigate the myocardial perfusion correlates of precordial ST segment depression during acute inferior myocardial infarction, a rest thallium-201 scintigram and a closely timed 12 lead electrocardiogram were obtained within 6 hours of the onset of infarction in 44 patients admitted with their first acute inferior myocardial infarction. Thirty-six patients demonstrated precordial ST segment depression (group 1) and eight did not (group 2). A perfusion defect involving the inferior wall was present in all 44 patients. Additional perfusion defects of the adjacent posterolateral wall (n . 20), the ventricular septum (n . 9) or both (n . 6) were present in 35 of 36 patients from group 1 compared with only 1 of 8 patients from group 2 (p less than 0.001). There was no significant difference in the frequency of multivessel coronary artery disease or disease of the left anterior descending artery between group 1 and group 2 or between patients with and those without a thallium-201 perfusion defect involving the ventricular septum. Thus, precordial ST segment depression during an acute inferior myocardial infarction is associated with thallium-201 scintigraphic evidence of more extensive involvement of the adjacent posterolateral or inferoseptal myocardial segments, which probably reflects the extent and pattern of distribution of the artery of infarction, rather than the presence of coexistent multivessel coronary artery disease or disease of the left anterior descending artery.

  4. Right and left ventricular ejection fraction after an acute inferior wall myocardial infarction and the value of V4R to predict the site of obstruction

    SciTech Connect

    Braat, S.H.; Brugada, P.; Den Dulk, K.; Wellens, H.J.J.

    1984-01-01

    This study was undertaken to compare the right (RVEF) and left ventricular ejection fraction (LVEF) after an acute inferior wall myocardial infarction (MI) caused by an obstruction in the right coronary artery (RCA) or circumflex coronary artery (CX) and to evaluate the value of lead V4R to predict the site of stenosis which caused the MI. In 42 consecutive patients (pts) admitted with an acute inferior wall MI a standard ECG and V4R were recorded. A nuclear angiogram was made one week after the acute MI and the RVEF and LVEF were calculated. Ten to 14 days (mean 12.7) after the acute MI a coronary angiogram was performed to determine the site of occlusion, which had caused the acute MI. According to the site of occlusion the pts were divided in three groups: Group A: the stenosis which had caused the MI was located in the RCA above the first branch to the right ventricle (RV); Group B: the stenosis was below the first branch to the RV in the RCA and Group C: the stenosis was located in the CX. The RVEF and LVEF in these groups are given. Nineteen pts had ST-segment elevation greater than or equal to 1 mm in V/sub 4/R and 17 of these pts had an obstruction above the first branch to the RV in the RCA. There is statistically no significant difference between the LVEF in the three different groups while the RVEF is significantly lower in group A. These pts can be identified by recording V4R.

  5. Predominant location of coronary artery atherosclerosis in the left anterior descending artery. The impact of septal perforators and the myocardial bridging effect

    PubMed Central

    Wasilewski, Jarosław; Niedziela, Jacek; Osadnik, Tadeusz; Duszańska, Agata; Sraga, Wojciech; Desperak, Piotr; Jackowska, Zuzanna; Nowakowski, Andrzej; Głowacki, Jan

    2015-01-01

    Introduction Coronary artery atherosclerosis presents characteristic patterns of plaque distribution despite systemic exposure to risk factors. We hypothesized that local hemodynamic forces induced by the systolic compression of intramuscular septal perforators could be involved in atherosclerotic processes in the left anterior descending artery (LAD) adjacent to the septal perforators’ origin. Therefore we studied the spatial distribution of atherosclerosis in coronary arteries, especially in relation to the septal perforators’ origin. Material and methods 64-slice computed tomography angiography was performed in 309 consecutive patients (92 male and 217 female) with a mean age of 59.9 years. Spatial plaque distribution in the LAD was analyzed in relation to the septal perforators’ origin. Additionally, plaque distribution throughout the coronary artery tree is discussed. Results The coronary calcium score (CCS) was positive in 164 patients (53.1%). In subjects with a CCS > 0, calcifications were more frequent in the LAD (n = 150, 91.5%) compared with the right coronary artery (RCA) (n = 94, 57.3%), circumflex branch (CX) (n = 76, 46.3%) or the left main stem (n = 42, 25.6%) (p < 0.001). Total CCS was higher in the LAD at 46.1 (IQR: 104.2) and RCA at 34.1 (IQR: 90.7) than in the CX at 16.8 (IQR: 61.3) (p = 0.007). In patients with calcifications restricted to a single vessel (n = 54), the most frequently affected artery was the LAD (n = 42, 77.8%). In patients with lesions limited to the LAD, the plaque was located mostly (n = 37, 88.1%) adjacent to the septal perforators’ origin. Conclusions We demonstrated that coronary calcifications are most frequently located in the LAD in proximity to the septal branch origin. A possible explanation for this phenomenon could be the dynamic compression of the tunneled septal branches, which may result in disturbed blood flow in the adjacent LAD segment (milking effect). PMID:26855661

  6. Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction: A Matched Case-control Study

    PubMed Central

    Jiang, Yue-Xin; Jing, Lin-De; Jia, You-Hong

    2015-01-01

    Background: Left ventricular thrombus (LVT) is reported to be a common complication in acute myocardial infarction (AMI) patients. And it has the potential to cause systemic embolism. This retrospective study was to present the current situation of LVT in clinical practice, as well as to evaluate the clinical characteristics and the risk factors of LVT after AMI. Methods: LVT cases (n = 96) were identified from 13,732 AMI (non-ST elevation myocardial infarction was excluded) patients in Fuwai Hospital's electronic medical records system from January 2003 to January 2013. The controls (n = 192) were gender- and age-matched AMI patients without LVT during this period. A conditional logistic regression (fitted by the Cox model) was performed to identify the independent risk factors. Results: The incidence of LVT after AMI was 0.7%. Univariate analysis indicated that the anterior myocardial infarction (especially extensive anterior myocardial infarction), lower left ventricular ejection fraction (LVEF), LVEF ≤40%, severe regional wall motion abnormalities (RWMA), pericardial effusion, and left ventricular aneurysm were all related to LVT after AMI. The independent risk factors obtained from the conditional logistic regression analysis were lower LVEF (odds ratio (OR) = 0.891, 95% confidence interval (CI): 0.828–0.960), extensive anterior myocardial infarction (OR = 6.403, 95% CI: 1.769–23.169), severe RWMA (OR = 7.348, 95% CI: 1.323–40.819), and left ventricular aneurysm (OR = 6.955, 95% CI: 1.673–28.921). Conclusions: This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice. PMID:26365955

  7. Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

    SciTech Connect

    Tan Wenyong; Wang Xiaohong; Qiu Dasheng; Liu Dong; Jia Shaohui; Zeng Fanyu; Chen Zhengwang; Li Beihui; Xu Jiaozhen; Wei Lai; Hu Desheng

    2011-12-01

    Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose-volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7-45.4% and 10.8-37.4%, respectively. The maximal dose to the heart decreased by 18.6-35.3%, to the AMT by 22.0-45.1%, and to the LV by 23.5-45.0%, And the relative volumes of the heart (V{sub {>=}12}), AMT (V{sub >11}) and LV (V{sub >10}) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving {>=}5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5-21.5%, 25.2-29.8%, and 22.8-29.8% and the maximal dose by 13.6-20.6%, 23.1-29.6%, and 17.3-29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.

  8. Antioxidant enzymes attenuate myocardial stunning in the conscious dog

    SciTech Connect

    Triana, J.F.; Unisa, A.; Bolli, R. )

    1990-02-26

    Several studies have shown that postischemic myocardial dysfunction (myocardial stunning) is attenuated by antioxidants, implying a pathogenetic role of oxy-radicals in this phenomenon. However, since all these studies have been performed in open-chest preparations, artifacts due to anesthesia, trauma, and other nonphysiologic conditions cannot be excluded. Accordingly, chronically instrumented dogs underwent a 15-minute occlusion (o) of the left anterior descending artery followed by reperfusion. Dogs received i.v. either saline or superoxide dismutase (SOD) plus catalase (CAT) (16,000 U/kg and 55,000 U/kg, respectively, over 1 hour starting 15 minutes before O). Regional myocardial function was assessed as systolic wall thickening (WTh) using a pulsed Doppler probe. WTh after reperfusion was significantly greater in treated dogs, and this difference could not be ascribed to differences in collateral flow or hemodynamics. The authors conclude that SOD plus catalase attenuate myocardial stunning in the conscious dog, indicating that oxy-radicals play a pathogenetic role in this phenomenon under physiologic conditions.

  9. A Bridge to a Woman's Heart as the Cause of Recurrent Chest Pain: A Case on Myocardial Bridge.

    PubMed

    Afzal, Ashwad; Korniyenko, Aleksandr; Haq, Salman

    2016-01-01

    Myocardial bridge is a congenital structural variant of the coronary arteries where a segment of the epicardial vessel is surrounded by the myocardium. It is an uncommon entity that may go unnoticed in patients with recurrent chest pain. We present a case on a 36-year-old woman with recurrent chest pain. Initial workup revealed normal routine laboratory test results, cardiac biomarkers, electrocardiogram, and an echocardiogram showing preserved ejection fraction with no valvulopathies. A dobutamine myocardial perfusion stress test was performed; this induced chest pain in the patient with electrocardiogram changes evident for 1-mm ST segment elevation in lead V5 and V6 consistent with myocardial ischemia. Perfusion imaging revealed a small fixed myocardial perfusion defect of the apical inferior wall. A cardiac catheterization revealed moderate-to-severe myocardial bridging involving the middle left anterior descending artery. Treatment with metoprolol and ranolazine resolved her symptoms. This case portrays the importance of recognizing myocardial bridge as the potential cause of recurrent chest pain and its ability to cause myocardial ischemia under stress. PMID:25723365

  10. Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

    SciTech Connect

    Sutherland, G.R.; Driedger, A.A.; Holliday, R.L.; Cheung, H.W.; Sibbald, W.J.

    1983-11-01

    Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly lower (31 +/- 11% and 47 +/- 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 +/- 8% and 58 +/- 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle.

  11. Quantitative Evaluation of Left Ventricular Wall Motion in Patient with Coronary Artery Bypass Grafting Using Magnetic Resonance Tagging Technique

    NASA Astrophysics Data System (ADS)

    Inaba, Tadashi; Nakano, Takahiro; Tsutsumi, Masakazu; Kawasaki, Shingo; Kinosada, Yasutomi; Tokuda, Masataka

    Left ventricular wall motions during systole were investigated from a mechanical perspective by using a magnetic resonance tagging technique. Subjects were 7 patients with coronary artery bypass grafting (CABG). First, by analyzing strain in the left ventricular wall, cardiac contractility was evaluated in the patients with CABG. Next, by calculating displacement in the myocardial wall, paradoxical movements following CABG were quantitatively evaluated. Strain analysis showed local decreases in circumferential strain in 4 of 7 subjects. The results of displacement analysis clarified that following CABG, the degree of radial displacement was small in the septal wall and large in the lateral wall, and circumferential displacement towards the septal wall occurred in the anterior and posterior walls. Since this behavior was seen in both reduced and normal cardiac contractility groups, paradoxical movements in the present patients were not caused by reduced cardiac contractility, but rather by rigid-body motion of the entire heart.

  12. Methane attenuates myocardial ischemia injury in rats through anti-oxidative, anti-apoptotic and anti-inflammatory actions.

    PubMed

    Chen, Ouyang; Ye, Zhouheng; Cao, Zhiyong; Manaenko, Anatol; Ning, Ke; Zhai, Xiao; Zhang, Rongjia; Zhang, Ting; Chen, Xiao; Liu, Wenwu; Sun, Xuejun

    2016-01-01

    Myocardial infarction (MI) remains the most frequent cardiovascular disease with high mortality. Recently, methane has been shown protective effects on small intestinal ischemia-reperfusion injury. We hypothesized that methane-rich saline (MS) could protect the myocardium again MI via its anti-oxidative, anti-apoptotic and anti-inflammatory effects. In experiment 1, tetrazolium chloride staining and detection of myocardial enzymes and oxidative and inflammatory parameters were performed at 12h after MI to determine the optimal dose at which intraperitoneal MS exerted the best protective effects on MI. In experiment 2, rats were treated with 10ml/kg MS. Myocyte apoptosis was detected 72h after MI, and cardiac function and myocardial remodeling were evaluated 4 weeks after MI. Results showed different dose of MS reduced infarct area, decreased myocardial enzymes, inhibited inflammation and oxidative stress following MI. The optimal dose of MS was 10mg/kg. Moreover, treatment with 10mg/kg MS for 3 days significantly reduced myocyte apoptosis, improved cardiac function and inhibited myocardial remodeling (reduced anterior wall thickness, attenuated myocyte hypertrophy, and decreased myocardial collagen). MS protects the myocardium of MI rats via its anti-oxidative, anti-inflammatory, anti-apoptotic and anti-remodeling activities. Thus, MS provides a novel and promising strategy for the treatment of ischemic heart diseases. PMID:26585905

  13. In vivo study of myocardial elastography under graded ischemia conditions

    NASA Astrophysics Data System (ADS)

    Lee, Wei-Ning; Provost, Jean; Fujikura, Kana; Wang, Jie; Konofagou, Elisa E.

    2011-02-01

    The capability of currently available echocardiography-based strain estimation techniques to fully map myocardial abnormality at early stages of myocardial ischemia is yet to be investigated. In this study, myocardial elastography (ME), a radio-frequency (RF)-based strain imaging technique that maps the full 2D transmural angle-independent strain tensor in standard echocardiographic views at both high spatial and temporal resolution is presented. The objectives were to (1) evaluate the performance of ME on mapping the onset, extent and progression of myocardial ischemia at graded coronary constriction levels (from partial to complete coronary flow reduction), and (2) validate the accuracy of the strain estimates against sonomicrometry (SM) measurements. A non-survival canine ischemic model (n = 5) was performed by gradually constricting the left anterior descending (LAD) coronary blood flow from 0% (baseline blood flow) to 100% (zero blood flow) at 20% increments. An open-architecture ultrasound system was used to acquire RF echocardiograms in a standard full short-axis view at the frame rate of 211 fps, at least twice higher than what is typically used in conventional echocardiographic systems, using a previously developed, fully automated composite technique. Myocardial deformation was estimated by ME and validated against sonomicrometry. ME estimates and maps transmural (1) 2D displacements using RF cross-correlation and recorrelation; and (2) 2D polar (radial and circumferential) strains, derived from 2D (i.e. both lateral and axial) displacement components, at high accuracy. Full-view strain images were shown and found to reliably depict decreased myocardial function in the region at risk at increased levels of coronary flow reduction. The ME radial strain was deemed to be a more sensitive, quantitative, regional measure of myocardial ischemia as a result of coronary flow reduction when compared to the conventional wall motion score index and ejection fraction. Good agreement (0.22% strain bias, 95% limits of agreement) using Bland-Altman analysis and good correlation (r = 0.84) were found between the ME and SM measurements. These findings demonstrate for the first time that ME could map angle-independent strains to non-invasively detect, localize and characterize the early onset of myocardial ischemia, i.e. at 40%, and possibly as low as 20%, LAD flow reduction, which could be further associated with the severity of coronary stenosis.

  14. In vivo study of myocardial elastography under graded ischemia conditions.

    PubMed

    Lee, Wei-Ning; Provost, Jean; Fujikura, Kana; Wang, Jie; Konofagou, Elisa E

    2011-02-21

    The capability of currently available echocardiography-based strain estimation techniques to fully map myocardial abnormality at early stages of myocardial ischemia is yet to be investigated. In this study, myocardial elastography (ME), a radio-frequency (RF)-based strain imaging technique that maps the full 2D transmural angle-independent strain tensor in standard echocardiographic views at both high spatial and temporal resolution is presented. The objectives were to (1) evaluate the performance of ME on mapping the onset, extent and progression of myocardial ischemia at graded coronary constriction levels (from partial to complete coronary flow reduction), and (2) validate the accuracy of the strain estimates against sonomicrometry (SM) measurements. A non-survival canine ischemic model (n = 5) was performed by gradually constricting the left anterior descending (LAD) coronary blood flow from 0% (baseline blood flow) to 100% (zero blood flow) at 20% increments. An open-architecture ultrasound system was used to acquire RF echocardiograms in a standard full short-axis view at the frame rate of 211 fps, at least twice higher than what is typically used in conventional echocardiographic systems, using a previously developed, fully automated composite technique. Myocardial deformation was estimated by ME and validated against sonomicrometry. ME estimates and maps transmural (1) 2D displacements using RF cross-correlation and recorrelation; and (2) 2D polar (radial and circumferential) strains, derived from 2D (i.e. both lateral and axial) displacement components, at high accuracy. Full-view strain images were shown and found to reliably depict decreased myocardial function in the region at risk at increased levels of coronary flow reduction. The ME radial strain was deemed to be a more sensitive, quantitative, regional measure of myocardial ischemia as a result of coronary flow reduction when compared to the conventional wall motion score index and ejection fraction. Good agreement (0.22% strain bias, 95% limits of agreement) using Bland-Altman analysis and good correlation (r = 0.84) were found between the ME and SM measurements. These findings demonstrate for the first time that ME could map angle-independent strains to non-invasively detect, localize and characterize the early onset of myocardial ischemia, i.e. at 40%, and possibly as low as 20%, LAD flow reduction, which could be further associated with the severity of coronary stenosis. PMID:21285479

  15. Rapamycin Treatment of Healthy Pigs Subjected to Acute Myocardial Ischemia-Reperfusion Injury Attenuates Cardiac Functions and Increases Myocardial Necrosis

    PubMed Central

    Lassaletta, Antonio D; Elmadhun, Nassrene Y; Zanetti, Arthus V D; Feng, Jun; Anduaga, Javier; Gohh, Reginald Y.; Sellke, Frank W; Bianchi, Cesario

    2013-01-01

    Background The Mechanistic Target of Rapamycin (mTOR) pathway is a major regulator of cell immunity and metabolism. mTOR is a well-known suppressor of tissue rejection in organ transplants, however, it has other non-immune functions including in the cardiovascular system, where it is a regulator of heart hypertrophy and locally, in coated vascular stents, inhibits vascular wall cell growth and hence neointimal formation/restenosis. Because the mTOR pathway plays major roles in normal cell growth, metabolism and survival, we hypothesized that inhibiting it with rapamycin, prior to an acute myocardial ischemia-reperfusion injury (IRI), would confer cardioprotection by virtue of slowing down cardiac function and metabolism. Methods Yorkshire pigs received orally either placebo or 4 mg/day rapamycin for 7 days before the IRI. All animals underwent median sternotomy and the mid-left anterior descending coronary artery was occluded for 60 min followed by 120 min of reperfusion. Left ventricular pressure-volume data was collected throughout the operation. The ischemic and infarcted areas were determined by monastral blue and triphenyltetrazolium chloride staining, respectively and plasma cardiac troponin I concentration. mTOR kinase activities were monitored in remote cardiac tissue by western blotting with specific antibodies against specific substrates phosphorylating sites. Results Rapamycin pre-treatement impaired endothelial-dependent vasorelaxation, attenuated cardiac function during IRI, and increased myocardial necrosis. Western blotting confirmed effective inhibition of myocardial mTOR kinase activities. Conclusions Pre-treatment of healthy pigs with rapamycin prior to acute myocardial IRI is associated with decreased cardiac function and higher myocardial necrosis. PMID:24266948

  16. Kappa-opioid receptor antagonism improves recovery from myocardial stunning in chronically instrumented dogs.

    PubMed

    Grosse Hartlage, Maike A; Theisen, Marc M; Monteiro de Oliveira, Nelson P; Van Aken, Hugo; Fobker, Manfred; Weber, Thomas P

    2006-10-01

    We tested the hypothesis that the selective kappa-opioid receptor antagonist nor-binaltorphimine (nor-BNI) improves recovery from myocardial stunning. Ten dogs were chronically instrumented for measurement of heart rate, left atrial, aortic and left ventricular pressure (LVP), and the maximum rate of LVP increase (LV dP/dt(max)) and decrease (LV dP/dt(max)), coronary blood flow velocity and myocardial wall-thickening fraction. Regional myocardial blood flow was determined with fluorescent microspheres. Catecholamine plasma levels were measured by high-performance liquid chromatography, and beta-endorphin and dynorphin plasma levels by radioimmunoassay. An occluder around the left anterior descending artery (LAD) allowed induction of a reversible LAD-ischemia. Animals underwent two experiments in a randomized crossover fashion on separate days: (a) 10 min LAD-occlusion (control experiment), (b) second ischemic episode 24 h after nor-BNI (2.5 mg/kg IV) (intervention). Dogs receiving nor-BNI showed an increase in wall-thickening fraction, LV dP/dt(max) and LV dP/dt(min) before ischemia and during the whole reperfusion (P < 0.05 versus control experiment). After nor-BNI pretreatment, dynorphin levels increased after induction of ischemia to a peak level of 15.1 +/- 3.6 pg/mL (P < 0.05 versus control experiment). The increase in plasma beta-endorphin during ischemia and early reperfusion was attenuated after nor-BNI. Compared with the control experiment, nor-BNI left global hemodynamics, regional myocardial blood flow, and catecholamine levels unchanged. In conclusion, nor-BNI improves recovery from myocardial stunning after regional myocardial ischemia in chronically instrumented dogs. PMID:17000788

  17. Myocardial bridging as a cause of acute myocardial infarction: a case report

    PubMed Central

    Akdemir, Ramazan; Gunduz, Huseyin; Emiroglu, Yunus; Uyan, Cihangir

    2002-01-01

    Background Systolic compression of a coronary artery by overlying myocardial tissue is termed myocardial bridging. Myocardial bridging usually has a benign prognosis, but some cases resulting in myocardial ischemia, infarction and sudden cardiac death have been reported. We are reporting a case of myocardial bridging which was complicated with acute myocardial infarction associated with inappropriate blood donation. Case presentation A 33 year-old-man was admitted to our emergency with acute anteroseptal myocardial infarction after a blood donation. The electrocardiography showed sinus rhythm and was consistent with an acute anteroseptal myocardial infarction. We decided to perform primary percutanous intervention (PCI). Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery on coronary angiogram. PCI was canceled and medical follow up was decided. Blood transfusion was made because he had a deep anemia. A normal hemaglobin level and clinical reperfusion was achieved after ten hours by blood transfusion. At the one year follow up visit, our patient was healthy and had no cardiac complaints. Conclusions Myocardial bridging may cause acute myocardial infarction in various clinical conditions. Although the condition in this case caused profound anemia related acute myocardial infarction, its treatment and management was unusual. PMID:12243650

  18. Myocardial Drug Distribution Generated from Local Epicardial Application: Potential Impact of Cardiac Capillary Perfusion in a Swine Model Using Epinephrine

    PubMed Central

    Maslov, Mikhail Y.; Edelman, Elazer R.; Pezone, Matthew J.; Wei, Abraham E.; Wakim, Matthew G.; Murray, Michael R.; Tsukada, Hisashi; Gerogiannis, Iraklis S.; Groothuis, Adam; Lovich, Mark A.

    2014-01-01

    Prior studies in small mammals have shown that local epicardial application of inotropic compounds drives myocardial contractility without systemic side effects. Myocardial capillary blood flow, however, may be more significant in larger species than in small animals. We hypothesized that bulk perfusion in capillary beds of the large mammalian heart enhances drug distribution after local release, but also clears more drug from the tissue target than in small animals. Epicardial (EC) drug releasing systems were used to apply epinephrine to the anterior surface of the left heart of swine in either point-sourced or distributed configurations. Following local application or intravenous (IV) infusion at the same dose rates, hemodynamic responses, epinephrine levels in the coronary sinus and systemic circulation, and drug deposition across the ventricular wall, around the circumference and down the axis, were measured. EC delivery via point-source release generated transmural epinephrine gradients directly beneath the site of application extending into the middle third of the myocardial thickness. Gradients in drug deposition were also observed down the length of the heart and around the circumference toward the lateral wall, but not the interventricular septum. These gradients extended further than might be predicted from simple diffusion. The circumferential distribution following local epinephrine delivery from a distributed source to the entire anterior wall drove drug toward the inferior wall, further than with point-source release, but again, not to the septum. This augmented drug distribution away from the release source, down the axis of the left ventricle, and selectively towards the left heart follows the direction of capillary perfusion away from the anterior descending and circumflex arteries, suggesting a role for the coronary circulation in determining local drug deposition and clearance. The dominant role of the coronary vasculature is further suggested by the elevated drug levels in the coronary sinus effluent. Indeed, plasma levels, hemodynamic responses, and myocardial deposition remote from the point of release were similar following local EC or IV delivery. Therefore, the coronary vasculature shapes the pharmacokinetics of local myocardial delivery of small catecholamine drugs in large animal models. Optimal design of epicardial drug delivery systems must consider the underlying bulk capillary perfusion currents within the tissue to deliver drug to tissue targets and may favor therapeutic molecules with better potential retention in myocardial tissue. PMID:25234821

  19. Interpolating scan and oblique-angle tomograms in myocardial PET using nitrogen-13 ammonia

    SciTech Connect

    Senda, M.; Yonekura, Y.; Tamaki, N.; Saji, H.; Koide, H.; Nohara, R.; Kambara, H.; Konishi, Y.; Torizuka, K.

    1986-12-01

    The effect of low sensitivity areas or gaps between adjacent slices of the multislice positron emission tomography on detection of myocardial perfusion abnormality with /sup 13/NH/sub 3/ was evaluated segmentally in 36 patients with coronary artery disease at rest or during exercise. The detectability of the defects in RCA or LAD region was 80% in single-position scans in stress studies. The false-negative defects were located mainly in the inferior wall, apicoinferior wall, or high anterior wall. When the patients were moved half the slice interval to perform the interpolating scan, and the two sets of images were interlaced with each other, the detectability increased to 88%. The interpolating scan also allowed reconstruction of long-axis and short-axis tomograms in high quality, which further improved the detectability of perfusion defects (100% for RCA or LAD and 75% for LCX lesion) and helped in understanding the anatomic relationships to the coronary artery territories.

  20. Acute myocardial infarction after bone marrow transplantation: an unsuspected late complication.

    PubMed

    Gatt, M E; Liebster, D; Leibowitz, D; Matzner, Y

    2003-02-01

    Acute myocardial infarction is a common disease rarely seen as a complication of bone marrow transplantation in young patients. We report on a 25-year-old patient 3.5 years after bone marrow transplantation who suffered an acute anterior wall myocardial infarction complicated by cardiogenic shock. The patient was treated with thrombolysis and emergent coronary angioplasty but died a few hours following admission. We suggest that the combination of low-dose chest irradiation and prolonged immunosuppression with graft-versus-host disease contributed to the development of the coronary artery disease in this patient. Though rarely encountered, physicians caring for young patients after bone marrow transplantation should be aware of potential ischemic complications. PMID:12601497

  1. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    PubMed Central

    Nakazone, Marcelo A.; Machado, Maurício N.; Barbosa, Raphael B.; Santos, Márcio A.; Maia, Lilia N.

    2010-01-01

    Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case. PMID:21052501

  2. Anterior cervical arachnoid cyst.

    PubMed

    Rahimizadeh, Abolfazl; Sharifi, Give

    2013-06-01

    This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome. PMID:23741550

  3. Biocement--a new material. Results of its experimental use for osseous repair of skull cap defects with lesions of the dura mater and liquorrhea, reconstruction of the anterior wall of the frontal sinuses and fixation of alloimplants.

    PubMed

    Raveh, J; Stich, H; Schawalder, P; Ruchti, C; Cottier, H

    1982-01-01

    A newly developed material, which we call biocement, consisting of bisphenol-a-glycidyl methacrylate ("epoxide methacrylate') as organic matrix and Bioceramic Battelle, Bioglass Hench and/or pentacalcium hydroxide triphosphate ("tri-calcium phosphate') powder as filling particles is presented. In an extension of previous experiments, various types of this biocement, containing different admixtures of particulate matter, were employed to test their usefulness in head surgery, in particular maxillo-facial reconstruction, on dogs and a rhesus monkey. Encouraging results were obtained with regard to (a) fixing a titanium alloimplant under some degree of mechanical stress; (b) covering a defect in the skull cap, including the closure of an artificially induced meningeal fistula with liquorrhea; and (c) reconstruction of defects in the anterior wall of frontal sinuses. Special emphasis is placed on direct contact between biocement and bone, interdigitations between these two, reactions of meningeal tissue, and regeneration of ciliated epithelium underneath fixed reimplants over the frontal sinus. PMID:6216717

  4. Secondary reconstruction with a transverse colon covered with a pectoralis major muscle flap and split thickness skin grafts for an esophageal defect and wide skin defects of the anterior chest wall.

    PubMed

    Sadanaga, Noriaki; Morinaga, Keigo; Matsuura, Hiroshi

    2015-12-01

    Necrosis of a reconstructed organ after esophagectomy is a rare postoperative complication. However, in case this complication develops, severe infectious complications can occur, and subsequent surgical reconstruction is quite complicated. To treat esophageal conduit necrosis after esophageal reconstruction with the terminal ileum and ascending colon, we reconstructed the esophagus using a transverse colon, which was covered with a pectoralis major muscle flap to reinforce the anastomotic site. In addition, split thickness skin grafts were applied to the wide skin defect to cover the reconstructed organs at the antesternal route. Widely extended split thickness skin grafts can adhere to the reconstructed organs without excessive tension. Therefore, this method enabled successful treatment of an esophageal defect and wide skin defects of the anterior chest wall. PMID:26943390

  5. Myocardial Bridge

    MedlinePlus

    ... Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden Cardiac Arrest Valve Disease Vulnerable Plaque ... Bridge | Share Related terms: myocardium, coronary arteries, myocardial ischemia Your heart is made of muscle, called the ...

  6. Bovine myocardial epithelial inclusions.

    PubMed

    Baker, D C; Schmidt, S P; Langheinrich, K A; Cannon, L; Smart, R A

    1993-01-01

    Light microscopic, histochemical, immunohistochemical, and ultrastructural methods were used to examine myocardial epithelial masses in the hearts of ten cattle. The tissues consisted of paraffin-embedded or formalin-fixed samples from eight hearts that were being inspected in slaughter houses and from two hearts from calves that died of septicemia. The ages of the cattle ranged from 4 days to 12 years; the breeds were unspecified for all but one Hereford female and the two Holstein calves; and there were three males, four females, and three steers. The masses in these cases were compared with similar appearing lesions found in other animal species. The lesions in the bovine hearts were single to multiple, well circumscribed, found in the left ventricle wall, and composed of squamous to cuboidal epithelial cells that formed tubular, ductular, and acinar structures with lumens that were void or filled with amorphous protein globules. Electron microscopic examination revealed epithelial cells that had sparse apical microvilli, tight apical intercellular junctions, perinuclear bundles of filaments, and rare cilia. Almost half of the bovine epithelial masses (4/9) had occasional diastase-resistant periodic acid-Schiff-positive granules in their cytoplasm, and few had hyaluronidase-resistant alcian blue-positive granules (2/9) or colloidal iron-positive granules (1/9). All myocardial masses had abundant collagen surrounding the tubular and acinar structures, and 2/9 had elastin fibers as well. None of the myocardial masses had Churukian-Schenk or Fontana Masson's silver staining granules in epithelial cells. Immunohistochemically, all bovine myocardial tumors stained positively for cytokeratin (8/8), and occasional masses stained positively for vimentin (3/8) or carcinoembryonic antigen (3/8). None of the masses stained positively for desmin. The myocardial epithelial tumors most likely represent endodermal rests of tissue misplaced during organogenesis. PMID:7680178

  7. A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging.

    PubMed

    Randall, David; Fenner, John; Gillott, Richard; Ten Broek, Richard; Strik, Chema; Spencer, Paul; Bardhan, Karna Dev

    2016-01-01

    Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results. Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion. The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential. PMID:26880884

  8. A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging

    PubMed Central

    Randall, David; Fenner, John; Gillott, Richard; ten Broek, Richard; Strik, Chema; Spencer, Paul; Bardhan, Karna Dev

    2016-01-01

    Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results. Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion. The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential. PMID:26880884

  9. Clinical, angiographic, hemodynamic, perfusional and functional changes after one-vessel left anterior descending coronary angioplasty

    SciTech Connect

    Okada, R.D.; Lim, Y.L.; Boucher, C.A.; Pohost, G.M.; Chesler, D.A.; Block, P.C.

    1985-02-01

    Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed in 20 patients with 1-vessel left anterior descending (LAD) coronary artery disease. Exercise capacity in terms of peak workload, heart rate and systolic blood pressure all increased significantly 1 week after PTCA. All patients had some decrease in stenosis size and gradient. All patients except 1 had an improvement in functional class. Eight of 12 patients with abnormal exercise electrocardiograms before PTCA had normal electrocardiograms after the procedure. Exercise thallium-201 (TI-201) myocardial perfusion images obtained in all 20 patients before and 1 week after PTCA were analyzed using a new computer method designed to quantitate regional myocardial TI-201 distribution, redistribution and clearance rate. Significant improvement in TI-201 activity was present in the anterior and septal segments of the left ventricle 1 week after PTCA. This increase in TI-201 uptake was associated with a significant reduction in the amount of TI-201 redistribution between initial and delayed postexercise images in the same regions. TI-201 clearance rate in the segments supplied by the dilated vessel also improved significantly. Abnormal TI-201 lung uptake was seen in 17 patients before and in 4 patients after PTCA. Exercise ejection fraction response and septal wall motion also improved after PTCA of the LAD stenosis in all 17 patients who had exercise radionuclide ventriculography.

  10. Mathematical model of blunt injury to the vascular wall via formation of rouleaux and changes in local hemodynamic and rheological factors. Implications for the mechanism of traumatic myocardial infarction

    PubMed Central

    Ismailov, Rovshan M

    2005-01-01

    Background Blood viscosity is fundamentally important in clinical practice yet the apparent viscosity at very low shear rates is not well understood. Various conditions such as blunt trauma may lead to the appearance of zones inside the vessel where shear stress equals zero. The aim of this research was to determine the blood viscosity and quantitative aspects of rouleau formation from erythrocytes at yield velocity (and therefore shear stress) equal to zero. Various fundamental differential equations and aspects of multiphase medium theory have been used. The equations were solved by a method of approximation. Experiments were conducted in an aerodynamic tube. Results The following were determined: (1) The dependence of the viscosity of a mixture on volume fraction during sedimentation of a group of particles (forming no aggregates), confirmed by published experimental data on the volume fractions of the second phase (f2) up to 0.6; (2) The dependence of the viscosity of the mixture on the volume fraction of erythrocytes during sedimentation of rouleaux when yield velocity is zero; (3) The increase in the viscosity of a mixture with an increasing erythrocyte concentration when yield velocity is zero; (4) The dependence of the quantity of rouleaux on shear stress (the higher the shear stress, the fewer the rouleaux) and on erythrocyte concentration (the more erythrocytes, the more rouleaux are formed). Conclusions This work represents one of few attempts to estimate extreme values of viscosity at low shear rate. It may further our understanding of the mechanism of blunt trauma to the vessel wall and therefore of conditions such as traumatic acute myocardial infarction. Such estimates are also clinically significant, since abnormal values of blood viscosity have been observed in many pathological conditions such as traumatic crush syndrome, cancer, acute myocardial infarction and peripheral vascular disease. PMID:15799779

  11. Value and limitations of segmental analysis of stress thallium myocardial imaging for localization of coronary artery disease

    SciTech Connect

    Rigo, P.; Bailey, I.K.; Griffith, L.S.C.; Pitt, B.; Borow, R.D.; Wagner, H.N.; Becker, L.C.

    1980-05-01

    This study was done to determine the value of thallium-201 myocardial scintigraphic imaging (MSI) for identifying disease in the individual coronary arteries. Segmental analysis of rest and stress MSI was performed in 133 patients with ateriographically proved coronary artery disease (CAD). Certain scintigraphic segments were highly specific (97 to 100%) for the three major coronary arteries: anterior wall and septum for the left anterior descending (LAD) coronary artery; the inferior wall for the right coronary artery (RCA); and the proximal lateral wall for the circumflex (LCX) artery. Perfusion defects located in the anterolateral wall in the anterior view were highly specific for proximal disease in the LAD involving the major diagonal branches, but this was not true for septal defects. The apical segments were not specific for any of the three major vessels. Although MSI was abnormal in 89% of these patients with CAD, it was less sensitive for identifying individual vessel disease: 63% for LAD, 50% for RCA, and 21% for LCX disease (narrowings > = 50%). Sensitivity increased with the severity of stenosis, but even for 100% occlusions was only 87% for LAD, 58% for RCA and 38% for LCX. Sensitivity diminished as the number of vessels involved increased: with single-vessel disease, 80% of LAD, 54% of RAC and 33% of LCX lesions were detected, but in patients with triple-vessel disease, only 50% of LAD, 50% of RCA and 16% of LCX lesions were identified. Thus, although segmented analysis of MSI can identify disease in the individual coronary arteries with high specificity, only moderate sensitivity is achieved, reflecting the tendency of MSI to identify only the most severely ischemic area among several that may be present in a heart. Perfusion scintigrams display relative distributions rather than absolute values for myocardial blood flow.

  12. Scintigraphic assessment of sympathetic innervation after transmural versus nontransmural myocardial infarction

    SciTech Connect

    Dae, M.W.; Herre, J.M.; O'Connell, J.W.; Botvinick, E.H.; Newman, D.; Munoz, L. )

    1991-05-01

    To evaluate the feasibility of detecting denervated myocardium in the infarcted canine heart, the distribution of sympathetic nerve endings using I-123 metaiodobenzylguanidine (MIBG) was compared with the distribution of perfusion using thallium-201, with the aid of color-coded computer functional map in 16 dogs. Twelve dogs underwent myocardial infarction by injection of vinyl latex into the left anterior descending coronary artery (transmural myocardial infarction, n = 6), or ligation of the left anterior descending coronary artery (nontransmural myocardial infarction, n = 6). Four dogs served as sham-operated controls. Image patterns were compared with tissue norepinephrine content and with histofluorescence microscopic findings in biopsy specimens. Hearts with transmural infarction showed zones of absent MIBG and thallium, indicating scar. Adjacent and distal regions showed reduced MIBG but normal thallium uptake, indicating viable but denervated myocardium. Denervation distal to infarction was confirmed by reduced norepinephrine content and absence of nerve fluorescence. Nontransmural myocardial infarction showed zones of wall thinning with decreased thallium uptake and a greater reduction or absence of MIBG localized to the region of the infarct, with minimal extension of denervation beyond the infarct. Norepinephrine content was significantly reduced in the infarct zone, and nerve fluorescence was absent. These findings suggest that (1) MIBG imaging can detect viable and perfused but denervated myocardium after infarction; and (2) as opposed to the distal denervation produced by transmural infarction, nontransmural infarction may lead to regional ischemic damage of sympathetic nerves, but may spare subepicardial nerve trunks that course through the region of infarction to provide a source of innervation to distal areas of myocardium.

  13. Quantitation of myocardial borderzone using reconstructive 3-D echocardiography after chronic infarction in rats: incremental value of low-dose dobutamine.

    PubMed

    Ghanem, Alexander; Troatz, Clemens; Elhafi, Naziha; Dewald, Oliver; Heeschen, Christopher; Nickenig, Georg; Stypmann, Joerg; Tiemann, Klaus

    2008-04-01

    Myocardial remodeling determines the degree of left ventricular dysfunction and mortality after transmural chronic myocardial infarction (CMI). Noninvasive characterization and quantitation of myocardial borderzone and collagenous scar are therefore parameters of clinical interest. The aims of this study were (i) to measure accuracy of reconstructive 3-D echocardiography (3DE) in scar and myocardial borderzone size assessment and (ii) to investigate the incremental value of low-dose dobutamine stress. 3DE was performed in 14 immunodeficient rats (rnu-rnu, 180-200 g) with anterior CMI 25 d after coronary ligation. Briefly, consecutive parallel short-axis cineloops were obtained electrocardiogram-gated starting from base to the apex. Morphology (mass, surface) and function (contractility, contractile reserve) of different compartments were assessed and correlated with 3-D histomorphometry. Histology was done using picrosirius red for collagen staining. 3DE left ventricular mass correlated closely with histomorphometry (y = 0.89x + 155, p < 0.0001, r = 0.80). Hypo- and akinetic myocardial surface correlated well with borderzone myocardium (y = 0.34x + 17, p = 0.009, r = 0.62) and collagenous scar (y = 1.9x + 4.4, p < 0.0001, r = 0.79), respectively. Extent of abnormal wall motion was closely related to borderzone and scar tissue area (y = 0.82x + 7, p < 0.0001, r = 0.77). 3DE quantitation of borderzone myocardium, but not collagenous scar, was more closely correlated to histomorphometry during inotropic stimulation. Global contractile reserve is positively associated with the size of myocardial borderzone. Regional contractile reserve of borderzone myocardium is not negatively associated with its collagen content. 3DE allows precise quantitation of myocardial borderzone and identification of transmural scar tissue noninvasively. Assessment of contractile reserve improves characterization and estimation of myocardial borderzone after CMI. PMID:17996357

  14. Prediction of single versus multivessel disease following myocardial infarction using 201-thallium scintigraphy and electrocardiographic stress testing

    SciTech Connect

    Weiss, R.J.; Morise, A.P.; Raabe, D.S. Jr.; Sbarbaro, J.A.

    1983-11-01

    Fifty patients were evaluated who suffered a single myocardial infarction with graded electrocardiographic stress testing, 201-thallium myocardial perfusion imaging and coronary angiography to assess the role of noninvasive indices as predictors of single versus multivessel coronary artery disease. Multivessel involvement was defined angiographically as the presence of two or more major coronary arteries with at least a 70% intraluminal diameter narrowing. Multivessel disease was defined scintigraphically as the presence of stress and/or redistribution perfusion defects in the distribution of more than one coronary artery. The results of stress electrocardiography were not useful in differentiating patients with single (9/16 positive) versus multivessel (22/34 positive) disease. The degree of exercise-induced ST-segment depression was also not helpful. Stress 201-thallium imaging did offer limited additional information with correct predictions of multivessel disease in 21 of 26 patients. Predictions of single-vessel disease were accurate in 11 of 24 patients. Eleven of these 13 incorrect predictions of single-vessel disease were due to the relative insensitivity of the thallium stress image to perceive defect in the anterior wall when the left anterior descending artery had significant obstruction at catheterization. Further refinements of stress perfusion imaging are needed before this method can be used to reliably separate patients with single and multivessel disease after myocardial infarction.

  15. Myocardial bridges over coronary arteries in Cercopithecus.

    PubMed

    Teofilovski, G; Filipovic, B; Bogdanovic, D; Trpinac, D; Rankovic, A; Stankovic, G; DiDio, L J

    1992-10-01

    The presence of myocardial bridges over the coronary arteries has been studied in 29 monkey (Cercopithecus aethiops) hearts. The great resemblance between the Cercopithecus subepicardial arterial net with the corresponding one in humans has been revealed. There is a high incidence (83%) of myocardial bridges only over the ventricular branches of both coronary arteries. Myocardial bridges are usually (90%) located over the left coronary artery branches, and the left anterior interventricular branch is the most frequently (69%) overbridged vessel. The bridges are always single over the vessel examined and their length varies from 0.5 mm to 31.6 mm. No statistically significant sexual difference in myocardial bridges distribution is reported. PMID:1449220

  16. Trauma Induced Myocardial Infarction

    PubMed Central

    Lolay, Georges A.; Abdel-Latef, Ahmed K.

    2016-01-01

    Chest Trauma in athletes is a common health problem. However, myocardial infarction secondary to coronary dissection in the setting of blunt chest trauma is extremely rare. We report a case of acute inferior wall myocardial infarction following blunt chest trauma. A 32-year-old male with no relevant medical problems was transferred to our medical center for retrosternal chest pain after being elbowed in the chest during a soccer game. Few seconds later, he started experiencing sharp retrosternal chest pain that was severe to that point where he called the emergency medical service. Upon arrival to the Trauma department patient was still complaining of chest pain. ECG demonstrated ST segment elevation in the inferior leads with reciprocal changes in the lateral leads all consistent with active ischemia. After rolling out Aortic dissection, patient was loaded with ASA, ticagerlor, heparin and was emergently taken to the cardiac catheterization lab. Coronary angiography demonstrated 100% thrombotic occlusion in the distal right coronary artery with TIMI 0 flow distally. After thrombus aspiration, a focal dissection was noted on the angiogram that was successfully stented. Two days after admission patient was discharged home. Echocardiography prior to discharge showed inferior wall akinesis, normal right ventricular systolic function and normal overall ejection fraction. PMID:26490501

  17. Trauma induced myocardial infarction.

    PubMed

    Lolay, Georges A; Abdel-Latif, Ahmed K

    2016-01-15

    Chest Trauma in athletes is a common health problem. However, myocardial infarction secondary to coronary dissection in the setting of blunt chest trauma is extremely rare. We report a case of acute inferior wall myocardial infarction following blunt chest trauma. A 32-year-old male with no relevant medical problems was transferred to our medical center for retrosternal chest pain after being elbowed in the chest during a soccer game. Few seconds later, he started experiencing sharp retrosternal chest pain that was severe to that point where he called the emergency medical service. Upon arrival to the trauma department patient was still complaining of chest pain. ECG demonstrated ST segment elevation in the inferior leads with reciprocal changes in the lateral leads all consistent with active ischemia. After rolling out aortic dissection, patient was loaded with ASA, ticagerlor, heparin and was emergently taken to the cardiac catheterization lab. Coronary angiography demonstrated 100% thrombotic occlusion in the distal right coronary artery with TIMI 0 flow distally. After thrombus aspiration, a focal dissection was noted on the angiogram that was successfully stented. Two days after admission patient was discharged home. Echocardiography prior to discharge showed inferior wall akinesis, normal right ventricular systolic function and normal overall ejection fraction. PMID:26490501

  18. Agreement in human interpretation of analog thallium myocardial perfusion images

    SciTech Connect

    Atwood, J.E.; Jensen, D.; Froelicher, V.; Witztum, K.; Gerber, K.; Gilpin, E.; Ashburn, W.

    1981-09-01

    To assess the agreement of human interpretation of analog thallium myocardial perfusion images, four experienced interpreters evaluated 100 images on two occasions using a form designed to limit reader variability. A high intraobserver agreement (agreement by same observer at separate times) of 89--93% was found when films were interpreted as normal or abnormal (a dichotomous decision). Interobserver agreement for a majority grouping of observers (three or four) was 75% for an abnormal and 68% for a normal interpretation. However, agreement ranged from 11--79% when interpreters were asked to read the anatomic location of defects. Posterior and lateral wall defects were interpreted with the least amount of agreement. These results indicate that caution must be taken when interpreting defect location. Using a scale of 1--10 to grade the severity of a defect, correlations of 0.82--0.86 were found when reading defects in the lateral and anterior projections. Higher correlations, from 0.86--0.94, were found in left anterior oblique views. Use of reporting forms with specific criteria, multiple observers at one occasion, and/or computer processing may improve agreement. A brief review of the agreement of cardiology testing procedures is also presented.

  19. Functional tests for myocardial ischemia

    SciTech Connect

    Levinson, J.R.; Guiney, T.E.; Boucher, C.A. )

    1991-01-01

    Functional tests for myocardial ischemia are numerous. Most depend upon a combination of either exercise or pharmacologic intervention with analysis of the electrocardiogram, of regional perfusion with radionuclide imaging, or of regional wall motion with radionuclide imaging or echocardiography. While each test has unique features, especially at the research level, they are generally quite similar in clinical practice, so the clinician is advised to concentrate on one or two in which local expertise is high.22 references.

  20. Schwarz Type C Myocardial Bridge Unraveled Post-Thrombus Aspiration in a Patient with Hypertrophic Cardiomyopathy.

    PubMed

    Singh, Satyajit; Kapoor, Aditya

    2015-01-01

    Hypertrophic cardiomyopathy (HCM), a heterogenous disease with diverse pathology and variable clinical course has a high prevalence of myocardial bridging. Despite the high prevalence of myocardial bridging in HCM patients, acute ST-elevation myocardial infarction (STEMI) due to concomitant atherothrombosis proximal to Schwarz type C myocardial bridge unraveled during trans-radial primary percutaneous intervention has rarely been reported in medical literature. Herein, we report a case of Schwarz type C myocardial bridge unmasked postthrombosuction in a patient with HCM presenting with acute STEMI. He had atherothrombosis proximal to the tunneled left anterior descending artery which was successfully stented with drug-eluting stent without the aid of intravascular ultrasound. PMID:26900419

  1. Schwarz Type C Myocardial Bridge Unraveled Post-Thrombus Aspiration in a Patient with Hypertrophic Cardiomyopathy

    PubMed Central

    Singh, Satyajit; Kapoor, Aditya

    2015-01-01

    Hypertrophic cardiomyopathy (HCM), a heterogenous disease with diverse pathology and variable clinical course has a high prevalence of myocardial bridging. Despite the high prevalence of myocardial bridging in HCM patients, acute ST-elevation myocardial infarction (STEMI) due to concomitant atherothrombosis proximal to Schwarz type C myocardial bridge unraveled during trans-radial primary percutaneous intervention has rarely been reported in medical literature. Herein, we report a case of Schwarz type C myocardial bridge unmasked postthrombosuction in a patient with HCM presenting with acute STEMI. He had atherothrombosis proximal to the tunneled left anterior descending artery which was successfully stented with drug-eluting stent without the aid of intravascular ultrasound. PMID:26900419

  2. Anterior chest wall inflammation by whole-body magnetic resonance imaging in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study

    PubMed Central

    2012-01-01

    Introduction Inflammatory involvement of the anterior chest wall (ACW) affects the quality of life of patients with spondyloarthritis (SpA), although involvement of the ACW is often neglected on clinical and imaging evaluation. Whole-body (WB) MRI is an imaging method used to assess the ACW in addition to the sacroiliac joints and spine without inconvenience for patients. Our goals in this study were to describe the distribution of ACW inflammation by WB MRI in both early and established SpA and associations between clinical and imaging findings indicative of inflammation. Methods The ACWs of 122 consecutive SpA patients (95 with ankylosing spondylitis (AS) and 27 with nonradiographic SpA (nrSpA)) and 75 healthy controls were scanned by sagittal and coronal WB MRI. The MRI scans were scored independently in random order by seven readers blinded to patient identifiers. Active and structural inflammatory lesions of the ACW were recorded on a web-based data entry form. ACW pain by patient self-report, ACW tenderness on physical examination according to the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and lesions detected by MRI were analyzed descriptively. κ statistics served to assess the agreement between clinical and imaging findings. Results ACW pain or tenderness was present in 26% of patients, with little difference between AS and nrSpA patients. Bone marrow edema (BME), erosion and fat infiltration were recorded in 44.3%, 34.4% and 27.0% of SpA patients and in 9.3%, 12.0% and 5.3% of controls, respectively. Lesions found by MRI occurred more frequently in AS patients (BME, erosion and fat infiltration in 49.5%, 36.8% and 33.7%, respectively) than in nrSpA patients (25.9%, 25.9% and 3.7%, respectively). The joint most frequently affected by lesions found on MRI scans was the manubriosternal joint. The κ values between clinical assessments and MRI inflammation ranged from -0.10 to only 0.33 for both AS and nrSpA patients. Conclusions Among SpA patients, 26% had clinical involvement of the ACW. WB MRI signs of ACW inflammation were found in a substantial proportion of patients with AS (49.5%) and nrSpA (25.9%). There was no association between clinical assessments of ACW, including the MASES, and MRI features. PMID:22226453

  3. Ultrasound targeted microbubble destruction promotes angiogenesis and heart function by inducing myocardial microenvironment change.

    PubMed

    Ling, Zhi-Yu; Shu, Shi-yu; Zhong, Shi-Gen; Luo, Jie; Su, Li; Liu, Zeng-Zhang; Lan, Xian-Bin; Yuan, Geng-Biao; Zheng, Yuan-Yi; Ran, Hai-Tao; Wang, Zhi-Gang; Yin, Yue-Hui

    2013-11-01

    The myocardial microenvironment plays a decisive role in the survival, migration and differentiation of stem cells. We studied myocardial micro-environmental changes induced by ultrasound-targeted microbubble destruction (UTMD) and their influence on the transplantation of mesenchymal stem cells (MSCs). Various intensities of ultrasound were applied to the anterior chest in canines with myocardial infarction after intravenous injection of microbubbles. The expression of cytokines and adhesion molecules in the infarcted area of the myocardium was detected after three sessions of UTMD in 1 wk. Real-time quantitative reverse transcription polymerase chain reaction (RTQ-PCR) showed that the expression of vascular cell adhesion molecule-1 (VCAM-1), stromal cell-derived factor-1 (SDF-1) and vascular endothelial growth factor (VEGF) in the 1.5 W/cm(2) and 1 W/cm(2) groups was markedly increased compared with the 0.5 W/cm(2) or the control groups (3.8- to 4.7-fold, p < 0.01), and the expression of interleukin-1β (IL-1β) in the 1.5 W/cm(2) group was increased twofold over the 1.0 W/cm(2) group, whereas the 0.5 W/cm(2) group experienced no significant changes. UTMD at 1.0 W/cm(2) was performed as previously described before mesenchymal stem cell (MSC) transplantation. Myocardial perfusion, angiogenesis and heart function were investigated before and 1 month after MSC transplantation. Coronary angiography and 99mTc-tetrofosmin scintigraphy revealed that myocardial perfusion was markedly improved after UTMD + MSCs treatment (p < 0.05). At echocardiographic analysis, heart function and the wall motion score index were significantly improved by UTMD + MSCs treatment compared with MSCs or UTMD alone and the control. In a canine model of myocardial infarction, therapeutic effects were markedly enhanced by MSC transplantation after the myocardial micro-environmental changes induced by UTMD; therefore, this novel method may be useful as an efficient approach for cellular therapy. PMID:23969167

  4. Computational modeling of acute myocardial infarction.

    PubMed

    Sáez, P; Kuhl, E

    2016-08-01

    Myocardial infarction, commonly known as heart attack, is caused by reduced blood supply and damages the heart muscle because of a lack of oxygen. Myocardial infarction initiates a cascade of biochemical and mechanical events. In the early stages, cardiomyocytes death, wall thinning, collagen degradation, and ventricular dilation are the immediate consequences of myocardial infarction. In the later stages, collagenous scar formation in the infarcted zone and hypertrophy of the non-infarcted zone are auto-regulatory mechanisms to partly correct for these events. Here we propose a computational model for the short-term adaptation after myocardial infarction using the continuum theory of multiplicative growth. Our model captures the effects of cell death initiating wall thinning, and collagen degradation initiating ventricular dilation. Our simulations agree well with clinical observations in early myocardial infarction. They represent a first step toward simulating the progression of myocardial infarction with the ultimate goal to predict the propensity toward heart failure as a function of infarct intensity, location, and size. PMID:26583449

  5. Myocardial Noncompaction Presenting With Myocardial Bridge: A Case Report.

    PubMed

    Shen, Yuechun; Li, Xinchun; Lu, Dongfeng; Xiao, Aiyi; Li, Jun

    2015-09-01

    Myocardial noncompaction, namly isolated noncompaction of the left ventricular myocardium (NVM), is a rare congenital disease. It can be either seen in the absence of other cardiac anomalies, or associated with other congenital cardiac defects, mostly stenotic lesions of the left ventricular outflow tract. A myocardial bridge (MB) is thought being associated with coronary heart disease, such as coronary spasm, arrhythmia, and so on. The significance of MB in association with other congenital cardiac conditions is unknown.We report a novel case who was presented NVM and MB. A 34-year-old man complained of chest prickling-like pain and dizzy for 1 year. His blood pressure was 110/70 mm Hg. Echocardiograph revealed increased trabeculations below the level of papillary muscle of left ventricle (LV); deep intertrabecular recesses in the endocardial wall of LV particularly in apex free wall; and LV ejection fraction of 57%. A coronary computerized tomography scan showed that part, 38.9 cm, of left descending artery tunnel was surrounding by cardiac muscles rather than resting on top of the myocardium.The therapeutics interventions included lifestyle cares, agents of anti-ischemia and improvement myocardial cell metabolism. The patient was followed up for 2.6 years, and his general condition was stable.This case indicates that NVM can be developed with MB, and the complete diagnosis of NVM and MB should be made by different image studies. PMID:26356695

  6. Cardiac venous arterialization in acute myocardial infarction: how great is the benefit?

    PubMed Central

    Munz, Maria; Amorim, Mário J.; Faria, Miguel; Vicente, Corália; Pinto, Ana; Monteiro, Joana; Leite-Moreira, Adelino F.; Águas, Artur P.

    2013-01-01

    OBJECTIVES Cardiac venous arterialization has been proposed as an alternative approach for myocardial revascularization in ischaemic heart disease. It is based on using the cardiac venous system to transport arterial blood from a systemic artery to infarcted myocardial areas. Our goal was to evaluate its benefit in reducing acute myocardial infarct size and its effects on cardiac performance. METHODS In a group of pigs, the left internal mammary artery was anastomosed to the left anterior descending vein; this vein was ligated proximally. The left anterior descending coronary artery was also occluded. Over 5 days, several diagnostic procedures were used to characterize and measure the extent of myocardial infarct, namely ECG, echocardiography, cardiac biomarkers and histopathology. Data were compared with those from a control group of pigs, which were submitted to ligation of only the left anterior descending coronary artery. RESULTS In the experimental group, echocardiography revealed that the ejection fraction and thickness of the ventricular walls remained unchanged 4 days after surgery, in contrast to the major alterations in the control group. In fact, the ejection fraction in the control group decreased by 21% (P < 0.001), with a reduction of 31% (P < 0.004) in the thickness of the interventricular septum at end systole and enlargement of the left ventricular lumen by 28% (P < 0.001). In the experimental group, the sum for ST segment shift was 50% lower (P = 0.038) and the total ventricular histological lesion size was 50% smaller (P < 0.001). Within this lesion, the area of necrotic tissue was 70% smaller (P < 0.001). Cardiac biomarkers were not different between the two groups (P > 0.2). CONCLUSIONS This study reveals that selective cardiac venous arterialization can nourish the myocardium and is able to reduce infarct size by more than 50%, while protecting cardiac performance. We believe, therefore, that further investigation should be carried out into this technique in order for it to be considered as an option in coronary surgery. PMID:23203313

  7. Acute myocardial infarction following scorpion sting in a case with obstructive coronary artery disease

    PubMed Central

    Patra, Soumya; K, Satish; Singla, Vivek; KS, Ravindranath

    2013-01-01

    The occurrence of an acute myocardial infarction (MI) following a scorpion sting has been very rarely reported in the previous literature. Possible pathogenetic mechanisms include severe hypotension due to hypovolaemic shock and coronary spasm with subsequent thrombosis of coronary vessels developed after the release of vasoactive, inflammatory and thrombogenic substances contained in the scorpion venom. All of the previously reported cases had normal coronary angiogram. We report a case of a 65-year-old woman who presented with severe scorpion sting and was treated with prazosin. But a few hours later, she developed acute anterior wall MI. Coronary angiogram revealed the presence of significant stenosis in coronary arteries. As acute MI owing to significant coronary artery disease can be evident after severe scorpion envenomation, so every case of acute coronary syndrome following scorpion sting needs early diagnosis, thorough cardiovascular evaluation and appropriate treatment. PMID:23715842

  8. Myocardial revascularisation after acute myocardial infarction.

    PubMed

    Bana, A; Yadava, O P; Ghadiok, R; Selot, N

    1999-05-15

    One hundred and twenty-three patients had coronary artery bypass grafting (CABG) within 30 days of acute myocardial infarction (AMI) from May 1992 to November 1997. Commonest infarct was anterior transmural (61.8%) and commonest indication of surgery was post-infarct persistent or recurrent angina (69.1%). Ten patients were operated within 48 h and 36 between 48 h to 2 weeks of having MI. Out of these, nine patients were having infarct extension and cardiogenic shock at the time of surgery. Pre-operatively fourteen patients were on inotropes of which six also had intra-aortic balloon pump (IABP) support. All patients had complete revascularisation with 3.8+/-1.2 distal anastomoses per patient. By multivariate analysis, we found that independent predictors of post-operative morbidity [inotropes >48 h, use of IABP, ventilation >24 h, ICU stay >5 days] and complications [re-exploration, arrhythmias, pulmonary complications, wound infection, cerebrovascular accident (CVA)] were left ventricular ejection fraction (LVEF) <30%, Q-wave MI, surgery <48 h after AMI, presence of pre-operative cardiogenic shock and age >60 years (P < or = 0.01). Mortality at 30 days was 3.3%. LVEF <30%, Q-wave MI, surgery <48 h after AMI, presence of pre-operative cardiogenic shock and age >60 years were found to be independent predictors of 30 days mortality (P < or = 0.01). Ninety patients were followed up for a mean duration of 33 months (1 to 65 months). There were three late deaths and five patients developed recurrence of angina. To conclude, CABG can be carried out with low risk following AMI in stable patients for post-infarct angina. Patients who undergo urgent or emergent surgery and who have pre-operative cardiogenic shock, IABP, poor left ventricular functions, age >60 years and Q-wave MI are at increased risk. PMID:10549845

  9. Transient integral boundary layer method to calculate the translesional pressure drop and the fractional flow reserve in myocardial bridges

    PubMed Central

    Bernhard, Stefan; Möhlenkamp, Stefan; Tilgner, Andreas

    2006-01-01

    Background The pressure drop – flow relations in myocardial bridges and the assessment of vascular heart disease via fractional flow reserve (FFR) have motivated many researchers the last decades. The aim of this study is to simulate several clinical conditions present in myocardial bridges to determine the flow reserve and consequently the clinical relevance of the disease. From a fluid mechanical point of view the pathophysiological situation in myocardial bridges involves fluid flow in a time dependent flow geometry, caused by contracting cardiac muscles overlying an intramural segment of the coronary artery. These flows mostly involve flow separation and secondary motions, which are difficult to calculate and analyse. Methods Because a three dimensional simulation of the haemodynamic conditions in myocardial bridges in a network of coronary arteries is time-consuming, we present a boundary layer model for the calculation of the pressure drop and flow separation. The approach is based on the assumption that the flow can be sufficiently well described by the interaction of an inviscid core and a viscous boundary layer. Under the assumption that the idealised flow through a constriction is given by near-equilibrium velocity profiles of the Falkner-Skan-Cooke (FSC) family, the evolution of the boundary layer is obtained by the simultaneous solution of the Falkner-Skan equation and the transient von-Kármán integral momentum equation. Results The model was used to investigate the relative importance of several physical parameters present in myocardial bridges. Results have been obtained for steady and unsteady flow through vessels with 0 – 85% diameter stenosis. We compare two clinical relevant cases of a myocardial bridge in the middle segment of the left anterior descending coronary artery (LAD). The pressure derived FFR of fixed and dynamic lesions has shown that the flow is less affected in the dynamic case, because the distal pressure partially recovers during re-opening of the vessel in diastole. We have further calculated the wall shear stress (WSS) distributions in addition to the location and length of the flow reversal zones in dependence on the severity of the disease. Conclusion The described boundary layer method can be used to simulate frictional forces and wall shear stresses in the entrance region of vessels. Earlier models are supplemented by the viscous effects in a quasi three-dimensional vessel geometry with a prescribed wall motion. The results indicate that the translesional pressure drop and the mean FFR compares favourably to clinical findings in the literature. We have further shown that the mean FFR under the assumption of Hagen-Poiseuille flow is overestimated in developing flow conditions. PMID:16790065

  10. Transcatheter Embolization of a Coronary Fistula Originating from the Left Anterior Descending Artery by Using N-Butyl 2-Cyanoacrylate

    SciTech Connect

    Karagoz, Tevfik; Celiker, Alpay E-mail: tkaraqoz@hacettepe.edu.tr; Cil, Barbaros; Cekirge, Saruhan

    2004-11-15

    In this report, we describe a successful percutaneous transcatheter n-butyl 2-cyanoacrylate embolization of a coronary fistula originating from the left anterior descending artery in an adolescent with unexpected recurrent attacks of myocardial ischemia.

  11. Influence of intracoronary nifedipine on left ventricular function, coronary vasomotility, and myocardial oxygen consumption.

    PubMed Central

    Serruys, P W; Hooghoudt, T E; Reiber, J H; Slager, C; Brower, R W; Hugenholtz, P G

    1983-01-01

    The effect of intracoronary nifedipine on regional and global left ventricular performance, coronary vasomotility, and myocardial oxygen consumption is reported. Left ventricular pressures and volume indices of contractility and relaxation were simultaneously recorded in five patients without coronary artery disease. In these patients, nifedipine in the left main coronary artery not only delayed (+115 ms) anterior wall contraction but also slowed (3.5 vs 1.9 cm/s) and depressed it (-26%), resulting in a depression of global left ventricular ejection. This asynchrony and depression of regional contraction is considered to be responsible for the slowed isovolumic contraction and relaxation of the whole ventricle. In 10 other patients with coronary artery disease, coronary sinus blood flow and myocardial oxygen consumption were measured before and after intracoronary nifedipine. The observed decrease in myocardial oxygen consumption (-28%) depended primarily on a decrease in contractility and left ventricular performance. In a third study group of 12 patients with coronary artery disease, the effects of intracoronary nifedipine on the coronary vasomotility of 40 coronary segments (normal, prestenotic, stenotic, poststenotic) were quantitatively determined. Left ventricular haemodynamics and coronary sinus saturation were monitored while the cineangiograms were recorded before and after nifedipine. Nifedipine provoked vasodilatation of the normal (+10.3%), prestenotic, stenotic (+4 to 30%), and poststenotic (+16.4%) coronary segments, which persisted after the disappearance of its direct effects on the myocardium. This transient regional "cardioplegic" effect of nifedipine, associated with an increase in coronary blood flow, a reduction in myocardial oxygen consumption, and a vasodilatation of the epicardial vessels is likely to be beneficial during temporary coronary occlusion such as occurs in spasm or transluminal angioplasty. Images PMID:6838731

  12. Bilateral Anterior Shoulder Dislocation

    PubMed Central

    Siu, Yuk Chuen; Lui, Tun Hing

    2014-01-01

    Introduction: Unilateral anterior shoulder dislocation is one of the most common problems encountered in orthopedic practice. However, simultaneous bilateral anterior dislocation of the shoulders is quite rare. Case Presentation: We report a case of a 75-year-old woman presented with simultaneous bilateral anterior shoulder dislocation following a trauma, complicated with a traction injury to the posterior cord of the brachial plexus. Conclusions: Bilateral anterior shoulder dislocation is very rare. The excessive traction force during closed reduction may lead to nerve palsy. Clear documentation of neurovascular status and adequate imaging before and after a reduction should be performed. PMID:25685749

  13. Feasibility of voxel-based statistical analysis method for myocardial PET

    NASA Astrophysics Data System (ADS)

    Ram Yu, A.; Kim, Jin Su; Paik, Chang H.; Kim, Kyeong Min; Moo Lim, Sang

    2014-09-01

    Although statistical parametric mapping (SPM) analysis is widely used in neuroimaging studies, to our best knowledge, there was no application to myocardial PET data analysis. In this study, we developed the voxel based statistical analysis method for myocardial PET which provides statistical comparison results between groups in image space. PET Emission data of normal and myocardial infarction rats were acquired For the SPM analysis, a rat heart template was created. In addition, individual PET data was spatially normalized and smoothed. Two sample t-tests were performed to identify the myocardial infarct region. This developed SPM method was compared with conventional ROI methods. Myocardial glucose metabolism was decreased in the lateral wall of the left ventricle. In the result of ROI analysis, the mean value of the lateral wall was 29% decreased. The newly developed SPM method for myocardial PET could provide quantitative information in myocardial PET study.

  14. Detection of active left ventricular thrombosis during acute myocardial infarction using indium-111 platelet scintigraphy

    SciTech Connect

    Ezekowitz, M.D.; Kellerman, D.J.; Smith, E.O.; Streitz, T.M.

    1984-07-01

    Platelet scintigraphy with radioactive indium-111 may be used both to identify and to reflect the activity of thrombin in vivo in man. Forty-one patients with acute myocardial infarction were studied for active left ventricular thrombosis by platelet scintigraphy and followed until in-hospital death, discharge, or same-admission cardiac surgery for evidence of systemic embolization. Group 1 (n . 29) had transmural myocardial infarctions, of which 21 were anterior and eight were inferior. Group 2 (n . 12) had subendocardial myocardial infarctions. Those with subendocardial and transmural inferior myocardial infarctions had neither left ventricular thrombosis nor emboli. Ten (48 percent) of 21 with anterior transmural myocardial infarctions had left ventricular thrombosis by platelet scintigraphy. Three with and one without such thrombosis by scintigraphy had acute neurologic episodes. In the group with anterior myocardial infarctions, seven of ten patients with and four of 11 without left ventricular thrombosis received heparin subcutaneously. We conclude that platelet scintigraphy may be used to monitor antiplatelet and anticoagulant therapy in patients with anterior transmural myocardial infarctions who are at risk for left ventricular thrombosis and systemic embolization.

  15. Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction

    SciTech Connect

    Van Reet, R.E.; Quinones, M.A.; Poliner, L.R.; Nelson, J.G.; Waggoner, A.D.; Kanon, D.; Lubetkin, S.J.; Pratt, C.M.; Winters, W.L. Jr.

    1984-02-01

    Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r . 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.

  16. The pathophysiology of myocardial stunning: reversibility, accumulation and continuity of the ischemic myocardial damage after reperfusion.

    PubMed

    Miura, M; Matsu-oka, H; Saito, T; Kanazawa, T

    1991-09-01

    In order to understand the pathophysiology of myocardial stunning, reversibility, accumulation and continuity of ischemic myocardial damage after reperfusion should be studied. Then, to analyze these three factors, myocardial function, metabolism and morphology under ischemia and reperfusion were studied in anesthetized, open-chest dogs. When myocardial ischemia was induced by occlusion of the left anterior descending coronary artery, percentage regional systolic shortening (%SS) of ischemic myocardium sharply decreased and became stable 10 min after occlusion. After reperfusion, ischemic myocardium showed active shortening after within 30-min occlusion, but did not after more than 60-min occlusion. During 90-min of ischemia, extracellular K+ concentration (Ke) steeply increased for first 10 min and was almost stable for next 10 min. Then, Ke straightly increased till 90 min. Metabolic rates, calculated from myocardial tissue CO2 and pH, steeply increased for first 20 min and sharply decreased for next 10 min. After 30 min, these two variables were almost stable, near zero. By electron-microscopy with cytochemistry, distribution of Na/K ATPase to myocardial cell membrane was observed to be almost after 15-min occlusion but distinctly sparse with destruction of cell membrane after 30-min occlusion. Therefore, irreversible myocardial damage appears after about 20-min ischemia and is almost complete after 60 min. Reversibility of damage to ischemic myocardium after reperfusion may mainly occur within 60-min ischemia. Although stunned myocardium in a narrow sense is may appear after reperfusion within less than 20-min of ischemia, stunned myocardium in a broad sense may appear within less than 60-min ischemia. When reversible myocardial ischemia (4- or 15-min occlusion) was repeated after short time intervals (20-min reperfusion), %SS of ischemic myocardium was gradually decreased with each ischemic episode. Active shortening of ischemic myocardium disappeared after more than two episodes of 15-min occlusion. Fluctuation of PCO2, pH and Ke of ischemic myocardium was gradually depressed with each occlusion. Metabolic viability of ischemic myocardium was cumulatively depressed by repeated brief occlusion. Naturally, myocardial damage was more severe after repeated 15-min occlusion than after 4-min occlusion. Accumulation of ischemic myocardial damage may arise as brief ischemia, which only induces reversible damage, is repeated. At last, continuity of ischemic myocardial damage was studied. The effect of 5-min occlusion to %SS of ischemic myocardium was apparently reversed after 90-min reperfusion. Early contractile failure was advanced even after very short duration of ischemia. Thus, myocardial function will be latently damaged.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1658410

  17. Depression Increases Sympathetic Activity and Exacerbates Myocardial Remodeling after Myocardial Infarction: Evidence from an Animal Experiment

    PubMed Central

    Liu, Tao; Yuan, Xiaoran; Ruan, Bing; Sun, Lifang; Tang, Yanhong; Yang, Bo; Hu, Dan; Huang, Congxin

    2014-01-01

    Depression is an independent risk factor for cardiovascular events and mortality in patients with myocardial infarction (MI). Excessive sympathetic activation and serious myocardial remodeling may contribute to this association. The aim of this study was to discuss the effect of depression on sympathetic activity and myocardial remodeling after MI. Wild-type (WT) rats were divided into a sham group (Sham), a myocardial infarction group (MI), a depression group (D), and a myocardial infarction plus depression group (MI+D). Compared with controls, the MI+D animals displayed depression-like behaviors and attenuated body weight gain. The evaluation of sympathetic activity showed an increased level in plasma concentrations of epinephrine and norepinephrine and higher expression of myocardial tyrosine hydroxylase in the MI+D group than the control groups (p<0.05 for all). Cardiac function and morphologic analyses revealed a decreased fractional shortening accompanied by increased left ventricular dimensions, thinning myocardium wall, and reduced collagen repair in the MI+D group compared with the MI group (p<0.05 for all). Frequent premature ventricular contractions, prolonged QT duration and ventricular repolarization duration, shorted effective refractory period, and increased susceptibility to ventricular arrhythmia were displayed in MI+D rats. These results indicate that sympathetic hyperactivation and exacerbated myocardial remodeling may be a plausible mechanism linking depression to an adverse prognosis after MI. PMID:25036781

  18. Acute myocardial infarction following honeybee sting

    PubMed Central

    Puttegowda, Beeresh; Chikkabasavaiah, Nagamani; Basavappa, Ramesh; Akmal Khateeb, Syed Tanveer

    2014-01-01

    The occurrence of acute myocardial infarction following a honeybee sting has been very rarely reported in the previous literature. Possible pathogenetic mechanisms include severe hypotension, rarely hypertension and coronary vasospasm with subsequent thrombosis of coronary vessels developed after the release of vasoactive, inflammatory and thrombogenic substances contained in the bee venom. This syndrome is also known as Kounis syndrome. We report a case of a 32-year-old man who presented with acute inferior wall myocardial infarction within 3 h of honeybee sting. He was treated with thrombolytic therapy. Coronary angiogram revealed normal coronary arteries. PMID:24729117

  19. Myocardial imaging. Coxsackie myocarditis

    SciTech Connect

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-09-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

  20. Effect of ischemia and postischemic dysfunction on myocardial uptake of technetium-99m-labeled methoxyisobutyl isonitrile and thallium-201

    SciTech Connect

    Sinusas, A.J.; Watson, D.D.; Cannon, J.M. Jr.; Beller, G.A. )

    1989-12-01

    The myocardial uptake of a new technetium-99m-labeled myocardial perfusion agent, methoxyisobutyl isonitrile (Tc-99m MIBI), and thallium-201 was correlated with microsphere flow in an open chest canine model of low coronary flow and postischemic dysfunction. Eighteen dogs were given an injection of thallium-201 (0.5 mCi) and Tc-99m MIBI (5 mCi) either after 40 min of partial left anterior descending artery occlusion (Group I, 10 dogs) or during reperfusion after 15 min of left anterior descending artery occlusion (Group II, 8 dogs). Regional dysfunction was documented during injection in both groups by quantitative two-dimensional echocardiography. Regional blood flow was assessed by radiolabeled microspheres. The heart was excised 15 min after radionuclide injection and the left ventricle divided into 96 segments for gamma well counting. Among Group I dogs, central ischemic thallium-201 and Tc-99m MIBI activity (expressed as a percent of the activity in the corresponding nonischemic zone) was comparable, respectively, for endocardial (54 +/- 17% and 52 +/- 17%), mid-wall (71 +/- 20% and 69 +/- 17%) and epicardial (89 +/- 13% and 94 +/- 9%) segments and increased proportionally with flow. There was a good linear correlation among these endocardial segments between flow and both thallium-201 (r = 0.78) and Tc-99m MIBI (r = 0.85) activity. Among Group II dogs, central ischemic endocardial flow (59 +/- 14%) was comparable to thallium-201 (70 +/- 18%) and Tc-99m MIBI (74 +/- 12%) activity. Similarly, relative endocardial flow in the intermediate ischemic region (71 +/- 11%) was comparable to thallium-201 (77 +/- 11%) and Tc-99m MIBI (81 +/- 10%) activity. Thus, myocardial uptake of Tc-99m MIBI and thallium-201 is comparable under conditions of low coronary flow and postischemic dysfunction and closely parallels flow alterations.

  1. Effects of time required for reperfusion (thrombolysis or angioplasty, or both) and location of acute myocardial infarction on left ventricular functional reserve capacity several months later

    SciTech Connect

    Little, T.; Crenshaw, M.; Liberman, H.A.; Battey, L.L.; Warner, R.; Churchwell, A.L.; Eisner, R.L.; Morris, D.C.; Patterson, R.E. )

    1991-04-15

    The purpose of this study was to determine whether reperfusion of acute myocardial infarction (AMI) by recombinant tissue-type plasminogen activator (rt-PA) or percutaneous transluminal coronary angioplasty, or both, would improve left ventricular (LV) function when it is measured several months later at rest or maximal bicycle exercise, or both. Radionuclide angiography was performed in 44 patients 5 months (range 6 weeks to 9 months) after AMI to assess function, and tomographic myocardial thallium-201 imaging was performed at maximal exercise and delayed rest to determine whether there was any evidence of myocardial ischemia. As expected, no patient had chest pain or redistribution of a thallium defect during the exercise test, because patients had undergone angioplasty (n = 28) or coronary bypass graft surgery (n = 5) where clinically indicated for revascularization. The LV ejection fraction was plotted as a function of the time elapsed between the onset of chest pain and the time when coronary angiography confirmed patency of the infarct-related artery (achieved in 91% of 44 patients by rt-PA (n = 31) or percutaneous transluminal coronary angioplasty (n = 9) ). Functional responses differed markedly between patients with anterior (n = 20) versus inferior (n = 24) wall AMI. LV ejection fraction during exercise correlated with time to reperfusion in patients with an anterior wall AMI (r = -0.58; standard error of the estimate = 11.9%; p less than 0.02) but not in patients with an inferior AMI (r = 0.10; standard error of the estimate = 13.1%); difference not significant.

  2. Rapid and Efficient Production of Coronary Artery Ligation and Myocardial Infarction in Mice Using Surgical Clips

    PubMed Central

    Hensley, Michael Taylor; Vandergriff, Adam; Cores, Jhon; Henry, Eric; Allen, Tyler A.; Caranasos, Thomas George; Wang, Zegen; Zhang, Tianxia; Zhang, Jinying; Cheng, Ke

    2015-01-01

    Aims The coronary artery ligation model in rodents mimics human myocardial infarction (MI). Normally mechanical ventilation and prolonged anesthesia period are needed. Recently, a method has been developed to create MI by popping-out the heart (without ventilation) followed by immediate suture ligation. Mortality is high due to the time-consuming suture ligation process while the heart is exposed. We sought to improve this method and reduce mortality by rapid coronary ligation using a surgical clip instead of a suture. Methods and Results Mice were randomized into 3 groups: clip MI (CMI), suture MI (SMI), or sham (SHAM). In all groups, heart was manually exposed without intubation through a small incision on the chest wall. Unlike the conventional SMI method, mice in the CMI group received a metal clip on left anterior descending artery (LAD), quickly dispensed by an AutoSuture Surgiclip™. The CMI method took only 1/3 of ligation time of the standard SMI method and improved post-MI survival rate. TTC staining and Masson’s trichrome staining revealed a similar degree of infarct size in the SMI and CMI groups. Echocardiograph confirmed that both SMI and CMI groups had a similar reduction of ejection fraction and fraction shortening over the time. Histological analysis showed that the numbers of CD68+ macrophages and apoptotic cells (TUNEL-positive) are indistinguishable between the two groups. Conclusion This new method, taking only less than 3 minutes to complete, represents an efficient myocardial infarction model in rodents. PMID:26599500

  3. Death from undetected acute myocardial infarction secondary to coronary artery dissection after blunt thoracic trauma.

    PubMed

    Puanglumyai, Supot; Thamtakerngkit, Somboon; Lekawanvijit, Suree

    2016-01-01

    Blunt thoracic trauma is a common occurrence in automobile accidents. Acute myocardial infarction (AMI) caused by coronary dissection following blunt thoracic trauma is rare. We report a case of healthy 24-year-old man with a history of blunt thoracic injury with subsequent undetected AMI who died of acute decompensated heart failure 4days after the insult. The autopsy findings showed a 90% luminal narrowing of the left anterior descending coronary artery by dissecting hematoma, 3cm in length. The myocardium revealed transmural myocardial infarction affecting apex, most part of left ventricular free wall, and interventricular septum. Both lungs were heavy, wet, and noncrepitant. Histological findings of the infarcted myocardium were consistent with 3-5days post-AMI. Sections from both lungs revealed massive pulmonary edema, reflecting acute decompensated heart failure following a large AMI secondary to coronary dissection. Blunt thoracic trauma may obscure typical chest pain associated with cardiac ischemia especially in cases with a high tolerance for pain. PMID:26454807

  4. The Benefits of Prone SPECT Myocardial Perfusion Imaging in Reducing Both Artifact Defects and Patient Radiation Exposure

    PubMed Central

    Stathaki, Maria; Koukouraki, Sophia; Papadaki, Emmanouela; Tsaroucha, Angeliki; Karkavitsas, Nikolaos

    2015-01-01

    Background Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation. Objectives To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure. Methods We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the “gold standard” for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings. Results Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects. Conclusion Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed. PMID:26559981

  5. [Acute myocardial infarction during sport].

    PubMed

    Fujiwara, M; Asakuma, S; Nakamura, K; Nakamura, T; Yasutomi, N; Iwasaki, T

    1995-10-01

    Thirty patients with acute myocardial infarction which occurred during sport were investigated to identify the type of sport, prodromata, situations at the onset of disease, habit of exercise, preceding medical evaluation, coronary risk factors, and coronary angiographic findings. Infarction occurred during golf in 12 patients, bowling in 4, gateball in 4, jogging or running in 5, baseball in 2, and tennis or table tennis in 3. The majority of the patients were playing ball games. Twenty-seven patients were men (90%) and 3 were women (10%). All patients had played the same kind of sport for several years. Twenty-four patients had one or more coronary risk factors, and especially 18 patients smoked cigarettes. Nine patients had experienced anterior chest pain but only two patients had received medical evaluation. Coronary angiography was performed in 25 patients (83.3%), revealing single-vessel disease in 14, two-vessel disease in 6, three-vessel disease in 4, and disease of all left main coronary trunks in 1. The acute episode of infarction occurred mainly in spring or fall. Many patients with acute myocardial infarction occurring during sport participate in sports of low or moderate dynamic and low static exercises which are generally regarded safe. Many patients had enjoyed their sports regularly for a long time. Though many patients had coronary risk factors, only a few had received a medical check before their heart attack. PMID:7500263

  6. Neutrophil to Lymphocyte Ratio Predicts Left Ventricular Remodeling in Patients with ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

    PubMed Central

    Börekçi, Abdurrezzak; Gür, Mustafa; Türkoğlu, Caner; Baykan, Ahmet Oytun; Şahin, Durmuş Yıldıray; Harbalıoğlu, Hazar; Elbasan, Zafer; Topuz, Mustafa; Çaylı, Murat

    2016-01-01

    Background and Objectives It has been demonstrated that the neutrophil/lymphocyte ratio (NLR) might be a useful marker to predict cardiovascular risk and events. We aimed to investigate the role of the NLR to predict ventricular remodeling (VR) in patients with anterior ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention. Subjects and Methods We prospectively included 274 consecutive anterior STEMI patients. Echocardiography was performed during admission and at six months after myocardial infarction. VR was defined as at least 20% increase from baseline in left ventricular end-diastolic volume. Patients were divided into two groups according to their VR status: VR (n=67) and non-VR (n=207). Total and differential leukocyte count, N-terminal pro-brain natriuretic peptide (NT-proBNP) and other biochemical markers were measured at admission and 24 hours later. Results Compared with the non-VR group, peak creatine kinase MB (CK-MB), NT-proBNP (24 h), neutrophil/lymphocyte ratio, presence of diabetes, no-reflow frequency and wall motion score index were significantly higher in patients with VR (p<0.05 for all). On multivariate logistic regression analysis, NLR (β=2.000, 95% confidence interval=1.577-2.537, p<0.001) as well as peak CK-MB, NT-proBNP (24 h), WMSI and diabetes incidence were associated with VR. The cutoff value of the neutrophil/lymphocyte ratio obtained by receiver operator characteristic curve analysis was 4.25 for the prediction of VR (sensitivity: 79 %, specificity: 74%). Conclusion In patients with anterior STEMI, initial NLR and NT-proBNP measured 24 hours after admission may be useful for predicting adverse cardiovascular events including left VR. PMID:26798381

  7. Effect of Wenxin Granule on Ventricular Remodeling and Myocardial Apoptosis in Rats with Myocardial Infarction

    PubMed Central

    Wu, Aiming; Zhai, Jianying; Zhang, Dongmei; Lou, Lixia; Zhu, Haiyan; Gao, Yonghong; Chai, Limin; Xing, Yanwei; Lv, Xiying; Zhu, Lingqun; Zhao, Mingjing; Wang, Shuoren

    2013-01-01

    Aim. To determine the effect of a Chinese herbal compound named Wenxin Granule on ventricular remodeling and myocardial apoptosis in rats with myocardial infarction (MI). Methods. Male Sprague-Dawley (SD) rats were randomly divided into four groups: the control group, the model group, the metoprolol group, and the Wenxin Granule group (WXKL group) with sample size (n) of 7 rats in each group. An MI model was established in all rats by occlusion of the left anterior descending coronary artery (the control group was without occlusion). Wenxin Granule (1.35 g/kg/day), metoprolol (12 mg/kg/day), and distilled water (5 mL/kg/day for the control and model groups) were administered orally for 4 weeks. Ultrasonic echocardiography was used to examine cardiac structural and functional parameters. Myocardial histopathological changes were observed using haematoxylin and eosin (H&E) dyeing. Myocardial apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) staining. Serum angiotensin II (Ang II) concentration was measured using the enzyme-linked immunosorbent assay (ELISA). Results. It was found that Wenxin Granule could partially reverse ventricular remodeling, improve heart function, alleviate the histopathological damage, inhibit myocardial apoptosis, and reduce Ang II concentration in rats with MI. Conclusions. The results of the current study suggest that Wenxin Granule may be a potential alternative and complementary medicine for the treatment of MI. PMID:23997803

  8. Association between Angiotensin II Type 1 Receptor Polymorphism and Sudden Cardiac Death in Myocardial Infarction

    PubMed Central

    Kruzliak, Peter; Kovacova, Gabriela; Pechanova, Olga; Balogh, Stefan

    2013-01-01

    Objective. The renin-angiotensin system is involved in the pathogenesis of coronary artery disease and myocardial infarction (MI). Angiotensin II (Ang II) has many adverse effects such as vasoconstriction and vascular remodeling, and these actions are mediated by the angiotensin II type 1 receptor (AT1R). Patients and Methods. A total of 1376 patients were recruited from January 2010 to April 2012. The study group consisted of 749 patients with ACS (317 females and 432 males) and of 627 healthy controls. Results. The ACS patients demonstrated a lower proportion of AA genotypes and AC genotypes but higher proportions of CC genotypes than the control population. The AT1R CC genotype conferred a 2.76-fold higher risk of MI compared with the genotype AC and AA. In addition, the CC genotype was also associated with a 4.08 times higher risk of left anterior descending artery infarction and a 3.07 times higher risk of anterior wall infarction. We also found that the CC genotype was independently associated with sudden cardiac death. In Summary. This study demonstrated that the AT1R CC genotype is an independent risk factor for ACS incidence, and this genotype is associated with a greater ACS severity and greater risk of sudden cardiac death. PMID:24167376

  9. Comparison Between Postprocessing Software and Repeated Scanning to Eliminate Subdiaphragmatic Activity in Myocardial Perfusion Scintigraphy

    PubMed Central

    Theerakulpisut, Daris; Chotipanich, Chanisa

    2016-01-01

    Myocardial perfusion single photon emission computed tomography (SPECT) is a powerful test of evaluation for coronary artery disease, but subdiaphragmatic radiotracer activity often interferes with the interpretation of inferior wall findings. This study aims to evaluate the effectiveness of using software elimination of the subdiaphragmatic activity for the assessment of its efficacy in the correctness of image interpretation and the overall image quality of myocardial perfusion scintigraphy (MPS). MPS studies from January 2010 to October 2012 at our institution were reviewed. Thirty-two SPECT studies were included, all of which had significant subdiaphragmatic activity in the first scan and needed to be delayed to let the activity clear. Each scan was interpreted by using semiquantitative scoring in 17 segments according to the degree of radiotracer uptake. The first scan, which had interfering activity, was manipulated by masking out the unwanted activity with software native to our image processing software suite. The manipulated images were then compared with delayed images of the same patient, of which the subdiaphragmatic activity was spontaneously cleared with time. The first scan masked by software correlated with the delayed scan for myocardial regions supplied by the left circumflex (LCx) and right coronary artery (RCA), but not the left anterior descending (LAD). However, the quality of the masked scans was perceived by the observer to be better in terms of quality and ease of interpretation. Using software to mask out unwanted subdiaphragmatic activity has no detrimental effect on the interpretation of MPS images when compared with delayed scanning, but it can improve subjective scan quality and ease of interpretation.

  10. Comparison Between Postprocessing Software and Repeated Scanning to Eliminate Subdiaphragmatic Activity in Myocardial Perfusion Scintigraphy.

    PubMed

    Theerakulpisut, Daris; Chotipanich, Chanisa

    2016-01-01

    Myocardial perfusion single photon emission computed tomography (SPECT) is a powerful test of evaluation for coronary artery disease, but subdiaphragmatic radiotracer activity often interferes with the interpretation of inferior wall findings. This study aims to evaluate the effectiveness of using software elimination of the subdiaphragmatic activity for the assessment of its efficacy in the correctness of image interpretation and the overall image quality of myocardial perfusion scintigraphy (MPS). MPS studies from January 2010 to October 2012 at our institution were reviewed. Thirty-two SPECT studies were included, all of which had significant subdiaphragmatic activity in the first scan and needed to be delayed to let the activity clear. Each scan was interpreted by using semiquantitative scoring in 17 segments according to the degree of radiotracer uptake. The first scan, which had interfering activity, was manipulated by masking out the unwanted activity with software native to our image processing software suite. The manipulated images were then compared with delayed images of the same patient, of which the subdiaphragmatic activity was spontaneously cleared with time. The first scan masked by software correlated with the delayed scan for myocardial regions supplied by the left circumflex (LCx) and right coronary artery (RCA), but not the left anterior descending (LAD). However, the quality of the masked scans was perceived by the observer to be better in terms of quality and ease of interpretation. Using software to mask out unwanted subdiaphragmatic activity has no detrimental effect on the interpretation of MPS images when compared with delayed scanning, but it can improve subjective scan quality and ease of interpretation. PMID:27134559

  11. A Murine Closed-chest Model of Myocardial Ischemia and Reperfusion

    PubMed Central

    Kim, Se-Chan; Boehm, Olaf; Meyer, Rainer; Hoeft, Andreas; Knüfermann, Pascal; Baumgarten, Georg

    2012-01-01

    Surgical trauma by thoracotomy in open-chest models of coronary ligation induces an immune response which modifies different mechanisms involved in ischemia and reperfusion. Immune response includes cytokine expression and release or secretion of endogenous ligands of innate immune receptors. Activation of innate immunity can potentially modulate infarct size. We have modified an existing murine closed-chest model using hanging weights which could be useful for studying myocardial pre- and postconditioning and the role of innate immunity in myocardial ischemia and reperfusion. This model allows animals to recover from surgical trauma before onset of myocardial ischemia. Volatile anesthetics have been intensely studied and their preconditioning effect for the ischemic heart is well known. However, this protective effect precludes its use in open chest models of coronary artery ligation. Thus, another advantage could be the use of the well controllable volatile anesthetics for instrumentation in a chronic closed-chest model, since their preconditioning effect lasts up to 72 hours. Chronic heart diseases with intermittent ischemia and multiple hit models are other possible applications of this model. For the chronic closed-chest model, intubated and ventilated mice undergo a lateral blunt thoracotomy via the 4th intercostal space. Following identification of the left anterior descending a ligature is passed underneath the vessel and both suture ends are threaded through an occluder. Then, both suture ends are passed through the chest wall, knotted to form a loop and left in the subcutaneous tissue. After chest closure and recovery for 5 days, mice are anesthetized again, chest skin is reopened and hanging weights are hooked up to the loop under ECG control. At the end of the ischemia/reperfusion protocol, hearts can be stained with TTC for infarct size assessment or undergo perfusion fixation to allow morphometric studies in addition to histology and immunohistochemistry. PMID:22847277

  12. Anterior ST depression with acute transmural inferior infarction due to posterior infarction. A vectorcardiographic and scintigraphic study

    SciTech Connect

    Mukharji, J.; Murray, S.; Lewis, S.E.; Croft, C.H.; Corbett, J.R.; Willerson, J.T.; Rude, R.E.

    1984-07-01

    The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both.

  13. Disseminated mucormycosis with myocardial involvement in a renal transplant recipient.

    PubMed

    Nam, Y; Jung, J; Park, S S; Kim, S J; Shin, S J; Choi, J H; Kim, M; Yoon, H E

    2015-12-01

    We report the case of a renal transplant recipient with pulmonary and splenic mucormycosis whose demise was accelerated by a myocardial abscess. Once pulmonary and splenic mucormycosis was diagnosed, liposomal amphotericin B was started and immunosuppressant treatments were discontinued. The pulmonary cavities regressed during treatment, but new myocardial and peri-allograft abscesses developed. The myocardial abscess diffusely infiltrated the left ventricular wall and was associated with akinesia, which led to sudden cardiac arrest. This case demonstrates a rare manifestation of mucormycosis and highlights the fatality and invasiveness of this infection. PMID:26538076

  14. A lotus root-like appearance in both the left anterior descending and right coronary arteries.

    PubMed

    Kadowaki, Hiromu; Taguchi, Eiji; Kotono, Yoshihiro; Suzuyama, Hiroto; Yoshida, Masayoshi; Miyamoto, Shinzo; Sakamoto, Tomohiro; Nishigami, Kazuhiro; Nakao, Koichi

    2016-01-01

    A 60-year-old man was referred to our hospital because of dyspnea on exertion. He was diagnosed with heart failure due to an old myocardial infarction. Myocardial stress perfusion scintigraphy revealed inducible myocardial ischemia. Coronary angiography revealed hazy slit lesions in both the left anterior descending (LAD) and right coronary arteries (RCA). We first performed percutaneous coronary intervention (PCI) on the LAD lesion. Subsequently, we performed PCI for the RCA lesion using multiple imaging modalities. We observed a lotus root-like appearance in both the LAD and RCA, and PCI was successful for both vessels. We describe this rare case in detail. PMID:25142445

  15. A case of myocardial bridging as a rare cause of chest pain in children.

    PubMed

    Poryo, Martin; Khreish, Fadi; Schäfers, Hans-Joachim; Abdul-Khaliq, Hashim

    2016-03-01

    Asymptomatic myocardial bridging is a frequently seen pathology in adult patients, often in association with hypertrophic cardiomyopathy. Left anterior descending coronary artery is mostly affected. We report on a 14-year-old boy with repeated angina-like pain, disturbances of repolarization in the ECG and elevated values for Troponin T. After exclusion of a myocarditis in the MRI, myocardial bridging was detectable in coronary angiography and confirmed by myocardial perfusion imaging with 430 MBq (99m)Tc-Tetrofosmin at rest and under physical stress. After surgical myotomy, improvement of the cardiac symptoms could be noted and myocardial perfusion imaging studies at rest and under stress demonstrated reversal of the myocardial ischemia. Myocardial bridging is a rare and important differential diagnosis for angina-like pain in childhood without hypertrophic cardiomyopathy. PMID:26349785

  16. Surgical therapy of an aberrant origin of the left anterior descending coronary artery from the right sinus of valsalva: a case report.

    PubMed

    Schreiber, Christian; Vogt, Manfred; Eicken, Andreas; Prodan, Zsolt; Libera, Paul; Lange, Rüdiger

    2006-01-01

    Anomalous aortic origin of a coronary artery from the incorrect coronary sinus of Valsalva is a rare congenital cardiac defect that is associated with an increased risk of sudden death. In most of these defects, the anomalous coronary artery takes an intramural course between the great arteries and leaves the aortic wall from the appropriate coronary sinus of Valsalva. Many times this anomalous artery shares a common orifice with the other coronary artery. We report on a previously healthy 15-year-old boy who presented with signs of an anterolateral myocardial infarction after physical activity (soccer game). Transthoracic echocardiography revealed an aberrant origin of the left anterior descending coronary artery from the right sinus of Valsalva. Repair was accomplished by unroofing the intramural segment. Because the intramural segment was below the commissure, detachment of the intercoronary commissure was not necessary. To conclude, transthoracic echocardiography can accurately depict this rare anomaly, and in symptomatic patients surgical therapy is indicated. PMID:16844631

  17. Comparison of radiological and morphologic assessments of myocardial bridges.

    PubMed

    Ercakmak, Burcu; Bulut, Elif; Hayran, Mutlu; Kaymaz, Figen; Bilgin, Selma; Hazirolan, Tuncay; Bayramoglu, Alp; Erbil, Mine

    2015-09-01

    In this study we aimed to compare the findings of coronary dual-source computed tomography angiography of myocardial bridges with cadaveric dissections. Forty-one isolated, non-damaged fresh sheep hearts were used in this study. Myocardial bridges of the anterior interventricular branch of the left coronary artery were demonstrated and analyzed by a coronary dual-source computed tomography angiography. Dissections along the left anterior interventricular branch of the left coronary artery were performed by using Zeiss OPMI pico microscope and the length of the bridges were measured. The depths of the myocardial bridges were measured from the stained sections by using the light microscope (Leica DM 6000B). MBs were found in all 41 hearts (100%) during dissections. Dual-source computed tomography angiography successfully detected 87.8% (36 of the 41 hearts) of the myocardial bridges measured on left anterior interventricular branch of left coronary artery. The lengths of the myocardial bridges were found 5-40 and 8-50 mm with dissection and dual-source computed tomography angiography, respectively. And the depths were found 0.7-4.5 mm by dual-source computed tomography angiography and 0.745-4.632 mm morphologically. Comparison of the mean values of the lengths showed statistically significantly higher values (22.0 ± 8.5, 17.7 ± 7.7 mm, p = 0.003) for the dissections. Radiological assessment also effectively discriminated complete bridges from incomplete ones. Our study showed that coronary computed tomography angiography is reliable in evaluating the presence and depth of myocardial bridges. PMID:25085008

  18. Myocardial ischemia with left ventricular outflow obstruction

    PubMed Central

    Popov, Aron F; Bireta, Christian; Schmitto, Jan D; Zenker, Dieter; Friedrich, Martin; Coskun, Kasim O; Seipelt, Ralf; Hanekop, Gerd G; Schoendube, Friedrich A

    2009-01-01

    We report an unusual case of a 32-year old man who was treated for a hypertrophic obstructive cardiomyopathy (HOCM) with a DDD pacing with short AV delay reduction in the past. Without prior notice the patient developed ventricular fibrillation and an invasive cardiac diagnostic was performed, which revealed a myocardial bridging around of the left anterior descending artery (LAD). We suspected ischemia that could be either related to LAD artery compression or perfusion abnormalities due to AV delay reduction with related to diastolic dysfunction. PMID:19761610

  19. Simultaneous technetium-99m MIBI angiography and myocardial perfusion imaging

    SciTech Connect

    Baillet, G.Y.; Mena, I.G.; Kuperus, J.H.; Robertson, J.M.; French, W.J.

    1989-01-01

    Resting first-pass radionuclide angiography (FPRNA) was performed with the myocardial perfusion agent technetium-99m MIBI. In 27 patients, it was compared with technetium-99m diethylenetriamine pentaacetic acid FPRNA. A significant correlation was present in left (r = 0.93, p less than 0.001) as well as right (r = 0.92, p less than 0.001) ventricular ejection fraction measured with both radiopharmaceuticals. In 13 patients, MIBI derived segmental wall motion was compared with contrast ventriculography. A high correlation was present (p less than 0.001), and qualitative agreement was found in 38/52 segments. In 19 patients with myocardial infarction a significant correlation was present between MIBI segmental wall motion and perfusion scores (p less than 0.001). In ten patients with a history of myocardial infarction, 18 myocardial segments demonstrated diseased coronary vessels and impaired wall motion at contrast angiography. These segments were all identified by the MIBI wall motion and perfusion study. We conclude that MIBI is a promising agent for simultaneous evaluation of cardiac function and myocardial perfusion at rest.

  20. Dobutamine echocardiography and myocardial contrast echocardiography. Two new techniques for the assessment of myocardial viability.

    PubMed Central

    Cheirif, J; Meza, M; Murgo, J P

    1995-01-01

    As investigators have discovered that cardiac regions displaying resting wall motion abnormalities are not the necessary equivalent of myocardial scar (and therefore of irreversible injury) but are potentially viable regions rendered dysfunctional by stunning or hibernation, a new field of medicine has developed to identify viable myocardium that can improve in function after revascularization. Moreover, improvements in myocardial preservation and perfusion during coronary artery bypass grafting and percutaneous transluminal coronary angioplasty have enabled patients with poor resting ejection fractions to undergo safer revascularization. In this review, we describe briefly the diagnostic techniques most commonly used in identifying dysfunctional but viable myocardium. We give specific attention to the assets and limitations of these techniques and special emphasis to 2 promising new techniques: dobutamine echocardiography and myocardial contrast echocardiography. PMID:7787468

  1. Prevalence of Regional Myocardial Thinning and Relationship With Myocardial Scarring in Patients With Coronary Artery Disease

    PubMed Central

    Shah, Dipan J.; Kim, Han W.; James, Olga; Parker, Michele; Wu, Edwin; Bonow, Robert O.; Judd, Robert M.; Kim, Raymond J.

    2014-01-01

    Importance Regional left ventricular (LV) wall thinning is believed to represent chronic transmural myocardial infarction and scar tissue. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring. Objective To evaluate patients with regional myocardial wall thinning and to determine scar burden and potential for functional improvement. Design, Setting, and Patients Investigator-initiated, prospective, 3-center study conducted from August 2000 through January 2008 in 3 parts to determine (1) in patients with known coronary artery disease (CAD) undergoing CMR viability assessment, the prevalence of regional wall thinning (end-diastolic wall thickness ≤5.5 mm), (2) in patients with thinning, the presence and extent of scar burden, and (3) in patients with thinning undergoing coronary revascularization, any changes in myocardial morphology and contractility. Main Outcomes and Measures Scar burden in thinned regions assessed using delayed-enhancement CMR and changes in myocardial morphology and function assessed using cine-CMR after revascularization. Results Of 1055 consecutive patients with CAD screened, 201 (19% [95% CI, 17% to 21%]) had regional wall thinning. Wall thinning spanned a mean of 34% (95% CI, 32% to 37% [SD, 15%]) of LV surface area. Within these regions, the extent of scarring was 72% (95% CI, 69% to 76% [SD, 25%]); however, 18% (95% CI, 13% to 24%) of thinned regions had limited scar burden (≤50% of total extent). Among patients with thinning undergoing revascularization and follow-up cine-CMR (n=42), scar extent within the thinned region was inversely related to regional (r=−0.72, P<.001) and global (r=−0.53, P<.001) contractile improvement. End-diastolic wall thickness in thinned regions with limited scar burden increased from 4.4 mm (95% CI, 4.1 to 4.7) to 7.5 mm (95% CI, 6.9 to 8.1) after revascularization (P<.001), resulting in resolution of wall thinning. On multivariable analysis, scar extent had the strongest association with contractile improvement (slope coefficient, −0.03 [95% CI, −0.04 to −0.02]; P<.001) and reversal of thinning (slope coefficient, −0.05 [95% CI, −0.06 to −0.04]; P<.001). Conclusions and Relevance Among patients with CAD referred for CMR and found to have regional wall thinning, limited scar burden was present in 18% and was associated with improved contractility and resolution of wall thinning after revascularization. These findings, which are not consistent with common assumptions, warrant further investigation. PMID:23462787

  2. [Toxic anterior segment syndrome].

    PubMed

    Cornut, P-L; Chiquet, C

    2011-01-01

    Toxic anterior segment syndrome (TASS) is a general term used to describe acute, sterile postoperative inflammation due to a non-infectious substance that accidentally enters the anterior segment at the time of surgery and mimics infectious endophthalmitis. TASS most commonly occurs acutely following anterior segment surgery, typically 12-72h after cataract extraction. Anterior segment inflammation is usually quite severe with hypopyon. Endothelial cell damage is common, resulting in diffuse corneal edema. No bacterium is isolated from ocular samples. The causes of TASS are numerous and difficult to isolate. Any device or substance used during the surgery or in the immediate postoperative period may be implicated. The major known causes include: preservatives in ophthalmic solutions, denatured ophthalmic viscosurgical devices, bacterial endotoxin, and intraocular lens-induced inflammation. Clinical features of infectious and non-infectious inflammation are initially indistinguishable and TASS is usually diagnosed and treated as acute endophthalmitis. It usually improves with local steroid treatment but may result in chronic elevation of intraocular pressure or irreversible corneal edema due to permanent damage of trabecular meshwork or endothelial cells. PMID:21176994

  3. Stress thallium-201 myocardial scintigraphy for the detection of individual coronary arterial lesions in patients with and without previous myocardial infarction

    SciTech Connect

    Rigo, P.; Bailey, I.K.; Griffith, L.S.; Pitt, B.; Wagner, H.N. Jr.; Becker, L.C.

    1981-08-01

    The value of stress thallium-201 scintigraphy for detecting individual coronary arterial stenoses was analyzed in 141 patients with angiographically proved coronary artery disease, 101 with and 40 without a previous myocardial infarction. In patients without infarction, the sensitivity for detecting greater than 50 percent narrowing in the left anterior descending, the right and the left circumflex coronary artery was 66, 53 and 24 percent, respectively. In those with a previous infarction, the sensitivity for demonstrating disease in the artery corresponding to the site of infarction was 100 percent for the left anterior descending, 79 percent for the right and 63 percent for the left circumflex coronary artery. In patients with a prior anterior infarction, concomitant right or left circumflex coronary arterial lesions were detected in only 1 of 12 cases, whereas in those with previous inferior or inferolateral infarction, the sensitivity for left anterior descending coronary artery disease was 69 percent. Because of the reasonably high sensitivity for detecting left anterior descending arterial disease, irrespective of the presence and location of previous infarction, myocardial scintigraphy was useful in identifying multivessel disease in patients with a previous inferior infarction. However, because of its relative insensitivity for right or left circumflex coronary artery disease, scintigraphy proved to be a poor predictor of multivessel disease in patients with a prior anterior infarction and in patients without previous myocardial infarction.

  4. Role of leukocytes and platelets in acute myocardial infarction

    SciTech Connect

    Bednar, M.M.

    1986-01-01

    Myocardial ischemia initiates an inflammatory-like response in which invading neutrophils exacerbate the degree of injury. The effects of nafazatrom, a new antithrombotic agent, on leukocyte function in vitro and in vivo were related to its ability to salvage ischemic myocardium in an occulsion-reperfusion model of myocardial injury in the anesthetized dogs. Measurements of the neutrophil-specific myeloperoxidase enzyme in ischemic myocardium indicate that the smaller infarct size in dogs treated with nafazatrom is accompanied by a diminished leukocyte infiltration. The results obtained with nafazatrom emphasize the important role of the neutrophil in ischemia-induced myocardial damage. The possibility that myocardial ischemia-induced platelet deposition was secondary to a neutrophil-mediated event was assessed by the injection of PGI{sub 2}-washed autologous {sup 111}indium-labeled platelets and measuring the amount of radioactivity in different regions of the heart following a 90 min. occlusion of the left anterior descending coronary artery followed by reperfusion for periods up to 5 hrs. Neutropenia, induced with specific sheep anti-dog neutrophil antiserum, significantly reduced platelet accumulation in the ischemic myocardium following 5 hrs. reperfusion and abolished the transmural platelet distribution. These results suggest that myocardial platelet deposition is secondary to a neutrophil-mediated event in this occlusion-reperfusion model of myocardial injury.

  5. Wellens syndrome caused by spasm of the proximal left anterior descending coronary artery.

    PubMed

    Sheng, Fu-Qiang; He, Mao-Rong; Zhang, Mei-Lin; Shen, Guo-Ying

    2015-01-01

    Electrocardiographic characteristics of Wellens syndrome (WS) consist of deeply inverted T waves or biphasic T waves in anterior precordial leads. Studies have shown that patients with WS have critical stenosis or complete obstruction of the proximal left anterior descending coronary artery (LAD) and high risk for the development of extensive anterior myocardial infarction. Here, we reported a case presenting with WS and with a small plaque in the proximal LAD and slow flow in the LAD other than significant stenosis of the proximal LAD detected by coronary angiography. The mechanisms for WS of our case are discussed. PMID:25804484

  6. Effect of melatonin on oncosis of myocardial cells in the myocardial ischemia/reperfusion injury rat and the role of the mitochondrial permeability transition pore.

    PubMed

    Liu, L F; Qian, Z H; Qin, Q; Shi, M; Zhang, H; Tao, X M; Zhu, W P

    2015-01-01

    We aimed to evaluate the effect of melatonin on myo-cardial cell oncosis in the myocardial ischemia/reperfusion injury rat, and the role of the mitochondrial permeability transition pore (MPTP) therein. Sprague Dawley rats (N = 60) were randomly divided into five groups of 12 rats each: control, ischemia/reperfusion (I/R), melatonin treatment (MT), melatonin treatment + atractyloside (MT+ATR), and atractyloside (ATR). We prepared the myocardial ischemia/reperfusion model by reperfusion after the left anterior descending coronary artery was ligated for 30 min. The MT rats were given a 10 mg/kg MT intra-venous injection immediately thereafter; the MT+ATR rats were also given a 5 mg/kg ATR intravenous injection 15 min before the ischemia; the ATR rats were given the ATR injection only. After 2-h re-perfusion, myocardial tissue was extracted, the infarction size was determined, and myocardial ultrastructures were observed using electron microscopy. The expression level of the preoncosis receptor (porimin), which can induce membrane injury, was determined by western blot; the nicotinamide adenine dinucleotide (NAD(+)) content was determined spectrophotometrically. The four treatment groups showed upregulat-ed expression of myocardial porimin, increased myocardial infarction size, and reduced NAD(+) content (P < 0.05). Compared with the I/R and MT+ATR groups, MT rats showed downregulated expression of myo-cardial porimin, reduced myocardial infarct size, and increased myo-cardial cell NAD(+) content (P < 0.05). The above indices between the ATR and MT+ATR groups were not significantly different (P > 0.05). Thus, MT might protect myocardial ischemia/reperfusion rats by inhibiting MPTP opening and reducing myocardial cell oncosis. PMID:26214427

  7. Relationship of functional recovery to scar contraction after myocardial infarction in the canine left ventricle

    SciTech Connect

    Choong, C.Y.; Gibbons, E.F.; Hogan, R.D.; Franklin, T.D.; Nolting, M.; Mann, D.L.; Weyman, A.E.

    1989-04-01

    We have previously reported that regional wall motion abnormalities in a canine model of acute myocardial infarction may show substantial improvement in the first 6 weeks after infarction. To determine whether the mechanism of this improvement in function is the result of scar contraction within the infarct, we studied the relationship between changes in regional wall motion defined by cross-sectional echocardiography and the regional concentration of radioactive microspheres injected immediately before coronary occlusion and sampled 6 weeks after occlusion. Eight dogs underwent serial echocardiographic and microsphere blood flow measurements immediately before and 30 minutes, 48 hours, 1 week, 3 weeks, and 6 weeks after ligation of the left anterior descending or the left circumflex coronary artery. Wall motion and blood flow were measured in the short-axis section of the left ventricle at the level of the midpapillary muscle in each 10-degree radial segment around the circumference of the ventricle. Infarct histology was assessed at 6 weeks by means of the same radial coordinate system. Control data were collected in a similar manner from four dogs that underwent sham operations and had no histologic evidence of infarction. In all of the animals with infarcts, but not in the sham animals, the calculated preocclusion endocardial and epicardial blood flow values in the histologic infarct zone (252 +/- 44 and 168 +/- 17 ml/min/100 gm, respectively, mean +/- SEM) were significantly higher than those in the normal opposite wall (endocardial: 106 +/- 3 ml/min/100 gm, p less than 0.01); epicardial: 108 +/- 3 ml/min/100 gm, p less than 0.01. The location and circumferential extent of myocardium showing this elevation of preocclusion blood flow correlated well (r = 0.93, p less than 0.001) with the location and circumferential extent of the histologic infarct.

  8. Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block

    PubMed Central

    Falcão, Andréa; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares, José; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Filho, Roberto Kalil; Meneghetti, José C

    2015-01-01

    OBJECTIVES: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. OBJECTIVE: We sought to investigate rubidium-82 (82Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. METHODS: Thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82Rb-positron emission tomography studies and without left bundle branch block (GII). RESULTS: Stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p<0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). CONCLUSION: The data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients with left bundle branch block. PMID:26602518

  9. [Coronary artery disease, myocardial perfusion and ventricular function in Q-wave and non-Q-wave myocardial infarcts].

    PubMed

    Macieira-Coelho, E; Garcia-Alves, M; da Costa, B; Cantinho, G; Pedro, P; Dionisio, I; Gouveia, A; de Padua, F

    1997-04-01

    Controversy remains in considering non-Q wave myocardial infarction (NQMI) a distinct pathophysiological entity of Q wave myocardial infarction (QMI). In order to analyze the severity of coronary artery disease, extension of myocardial scar or myocardial ischemia and ventricular function, 78 consecutive patients with QMI and 32 with NQMI, mean age 55.4 +/- 8.5, not submitted to thrombolytic therapy, were studied. Coronary angiography, exercise thallium scintigraphy and radionuclide ventriculography were performed in all at least within 3 months of a prior myocardial infarction. In the present study the occurrence of QMI was significantly more frequent in older patients than NQMI. There was no prevalence of occlusion either in the right, left circumflex or left anterior descending coronary arteries in both groups. Ejection fraction, degree of occlusion and presence of collateral circulation showed an equal prevalence in QMI and NQMI patients. A higher incidence of multivessel disease was found in NQMI that had less necrosis than QMI patients. The prevalence of exercise induced thallium-201 redistribution defects within the infarct zone was substantially higher and involved more scar segments in NQMI patients. Physiological and clinical consequences of coronary thrombosis depends on the size and the number of diseased arteries, the approach the pathophysiologic consequences of coronary disease in terms of fractal structure has been suggested. A pronounced heterogeneity in regional myocardial blood flow in a fractal branching arterial network may be responsible for the pathophysiologic differences of coronary thrombosis between Q-wave and non Q-wave infarction. PMID:9341032

  10. Left anterior descending coronary artery stenosis: in a patient with takotsubo cardiomyopathy.

    PubMed

    Vittala, Satya S; Najib, Mohammad Q; Click, Roger L; Fortuin, F David; Chaliki, Hari P

    2012-01-01

    Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients.Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch.Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy. PMID:22412247

  11. Acute Anteroseptal Myocardial Infarction after a Negative Exercise Stress Test

    PubMed Central

    Al-Alawi, Abdullah M.; Janardan, Jyotsna; Peck, Kah Y.; Soward, Alan

    2016-01-01

    A myocardial infarction is a rare complication which can occur after an exercise stress test. We report a 48-year-old male who was referred to the Mildura Cardiology Practice, Victoria, Australia, in August 2014 with left-sided chest pain. He underwent an exercise stress test which was negative for myocardial ischaemia. However, the patient presented to the Emergency Department of the Mildura Base Hospital 30 minutes after the test with severe retrosternal chest pain. An acute anteroseptal ST segment elevation myocardial infarction was observed on electrocardiography. After thrombolysis, he was transferred to a tertiary hospital where coronary angiography subsequently revealed significant left anterior descending coronary artery stenosis. Thrombus aspiration and a balloon angioplasty were performed. The patient was discharged three days after the surgical procedure in good health. PMID:27226918

  12. Quantitative automated assessment of myocardial perfusion at cardiac catheterization.

    PubMed

    Boyle, Andrew J; Schuleri, Karl H; Lienard, Jean; Vaillant, Regis; Chan, Michael Y; Zimmet, Jeffrey M; Mazhari, Ramesh; Centola, Marco; Feigenbaum, Gary; Dib, Joud; Kapur, Navin K; Hare, Joshua M; Resar, Jon R

    2008-10-15

    Perfusion assessed in the cardiac catheterization laboratory predicts outcomes after myocardial infarction. The aim of this study was to investigate a novel method of assessing perfusion using digital subtraction angiography to generate a time-density curve (TDC) of myocardial blush, incorporating epicardial and myocardial perfusion. Seven pigs underwent temporary occlusion of the left anterior descending coronary artery for 60 minutes. Angiography was performed in the same projections before, during, and after occlusion. Perfusion parameters were obtained from the TDC and compared with Thrombolysis In Myocardial Infarction (TIMI) frame count and myocardial perfusion grade. In addition, safety and feasibility were tested in 8 patients after primary percutaneous coronary intervention. The contrast density differential between the proximal artery and the myocardium derived from the TDC correlated well with TIMI myocardial perfusion grade (R = 0.54, p <0.001). The arterial transit time derived from the TDC correlated with TIMI frame count (R = 0.435, p = 0.011). Using a cutoff of 2.4, the density/time ratio, a ratio of density differential to transit time, had sensitivity and specificity of 100% for coronary arterial occlusion. The positive and negative predictive values were 100%. The generation of a TDC was safe and feasible in 7 patients after acute myocardial infarctions, but the correlation between TDC-derived parameters and TIMI parameters did not reach statistical significance. In conclusion, this novel method of digital subtraction angiography with rapid, automated, quantitative assessment of myocardial perfusion in the cardiac catheterization laboratory correlates well with established angiographic measures of perfusion. Further studies to assess the prognostic value of this technique are warranted. PMID:18929697

  13. [Recurrent acute myocardial infarction as a thromboembolic complication of atrial fibrillation].

    PubMed

    Tomcsányi, János; Takó, Katalin; Sármán, Balázs

    2016-01-31

    Coronary thromboembolism with subsequent myocardial infarction is a rare complication of atrial fibrillation. The authors present the history of a 55-year-old male with a history of acute myocardial infarction caused by thromboembolism in the distal part of left anterior descending coronary artery and paroxysmal atrial fibrillation, who presented one year later with new chest pain, ST-segment elevation and atrial fibrillation. Coronarography confirmed the presence of thrombus in the circumflex coronary artery. Transesophageal echocardiogram showed left atrial appendage thrombus. To the knowledge of the authors this is the first report of recurrent myocardial infarction caused by atrial fibrillation. PMID:26801365

  14. Anterior urethral stricture review

    PubMed Central

    Stein, Marshall J.

    2013-01-01

    Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures. PMID:26816721

  15. Anterior mandibular ameloblastoma

    PubMed Central

    Bhandarwar, Ajay H.; Bakhshi, Girish D.; Borisa, Ashok D.; Wagh, Amol; Kapoor, Rajat; Kori, Channabasappa G.

    2012-01-01

    Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis-menti) is rare. Very few cases of midline anterior ameloblastomas are reported in the literature. They often require wide local excision. Reconstruction of mandible in these cases is challenging. We present a case of mandibular ameloblastoma arising from symphysis-menti. Patient underwent wide surgical excision of the tumor followed by immediate reconstruction using free fibular vascular flap, stabilized with titanium reconstructive plates. A brief case report ands review of literature is presented. PMID:24765429

  16. Concomitant Phosphodiesterase 5 Inhibition Enhances Myocardial Protection by Inhaled Nitric Oxide in Ischemia-Reperfusion Injury.

    PubMed

    Lux, Arpad; Pokreisz, Peter; Swinnen, Melissa; Caluwe, Ellen; Gillijns, Hilde; Szelid, Zsolt; Merkely, Bela; Janssens, Stefan P

    2016-02-01

    Enhanced cyclic guanosine monophosphate (cGMP) signaling may attenuate myocardial ischemia-reperfusion injury (I/R) and improve left ventricular (LV) functional recovery after myocardial infarction (MI). We investigated the cardioprotection afforded by inhaled NO (iNO), the phosphodiesterase 5 (PDE5)-specific inhibitor tadalafil (TAD), or their combination (iNO+TAD) in C57Bl6J mice subjected to 6-minute left anterior descending artery ligation followed by reperfusion. We measured plasma and cardiac concentrations of cGMP during early reperfusion, quantified myocardial necrosis and inflammation by serial troponin-I (TnI) and myeloperoxidase-positive cell infiltration at day 3, and evaluated LV function and remodeling after 4 weeks using echocardiography and pressure-conductance catheterization. Administration of iNO, TAD, or both during I/R was safe and hemodynamically well tolerated. Compared with untreated mice (CON), only iNO+TAD increased plasma and cardiac-cGMP levels during early reperfusion (80 ± 12 versus 36 ± 6 pmol/ml and 0.15 ± 0.02 versus 0.05 ± 0.01 pmol/mg protein, P < 0.05 for both). Moreover, iNO+TAD reduced TnI at 4 hours to a greater extent (P < 0.001 versus CON) than either alone (P < 0.05 versus CON) and was associated with significantly less myocardial inflammatory cell infiltration at day 3. After 4 weeks and compared with CON, iNO+TAD was associated with increased fractional shortening (43 ± 1 versus 33 ± 2%, P < 0.01), larger stroke volumes (14.9 ± 1.2 versus 10.2 ± 0.9 μl, P < 0.05), enhanced septal and posterior wall thickening (P < 0.05 and P < 0.001, respectively), and attenuated LV dilatation (P < 0.001), whereas iNO or TAD alone conferred less benefit. Thus, iNO+TAD has superior efficacy to limit early reperfusion injury and attenuate adverse LV remodeling. Combination of inhaled NO with a long-acting PDE5 inhibitor may represent a promising strategy to reduce ischemic damage following reperfusion and better preserve LV function. PMID:26621143

  17. Measurement of acute Q-wave myocardial infarct size with single photon emission computed tomography imaging of indium-111 antimyosin

    SciTech Connect

    Antunes, M.L.; Seldin, D.W.; Wall, R.M.; Johnson, L.L.

    1989-04-01

    Myocardial infarct size was measured by single photon emission computed tomography (SPECT) following injection of indium-111 antimyosin in 27 patients (18 male and 9 female; mean age 57.4 +/- 10.5 years, range 37 to 75) who had acute transmural myocardial infarction (MI). These 27 patients represent 27 of 35 (77%) consecutive patients with acute Q-wave infarctions who were injected with indium-111 antimyosin. In the remaining 8 patients either tracer uptake was too faint or the scans were technically inadequate to permit infarct sizing from SPECT reconstructions. In the 27 patients studied, infarct location by electrocardiogram was anterior in 15 and inferoposterior in 12. Nine patients had a history of prior infarction. Each patient received 2 mCi of indium-111 antimyosin followed by SPECT imaging 48 hours later. Infarct mass was determined from coronal slices using a threshold value obtained from a human torso/cardiac phantom. Infarct size ranged from 11 to 87 g mean (48.5 +/- 24). Anterior infarcts were significantly (p less than 0.01) larger (60 +/- 20 g) than inferoposterior infarcts (34 +/- 21 g). For patients without prior MI, there were significant inverse correlations between infarct size and ejection fraction (r = 0.71, p less than 0.01) and wall motion score (r = 0.58, p less than 0.01) obtained from predischarge gated blood pool scans. Peak creatine kinase-MB correlated significantly with infarct size for patients without either reperfusion or right ventricular infarction (r = 0.66). Seven patients without prior infarcts had additional simultaneous indium-111/thallium-201 SPECT studies using dual energy windows.

  18. Myocardial diseases of animals.

    PubMed

    Van Vleet, J F; Ferrans, V J

    1986-07-01

    In this review we have attempted a comprehensive compilation of the cardiac morphologic changes that occur in spontaneous and experimental myocardial diseases of animals. Our coverage addresses diseases of mammals and birds and includes these diseases found in both domesticated and wild animals. A similar review of the myocardial diseases in this broad range of animal species has not been attempted previously. We have summarized and illustrated the gross, microscopic, and ultrastructural alterations for these myocardial diseases; and, whenever possible, we have reviewed their biochemical pathogenesis. We have arranged the myocardial diseases for presentation and discussion according to an etiologic classification with seven categories. These include a group of idiopathic or primary cardiomyopathies recognized in man (hypertrophic, dilated, and restrictive types) and a large group of secondary cardiomyopathies with known causes, such as inherited tendency; nutritional deficiency; toxicity; physical injury and shock; endocrine disorders, and myocarditides of viral, bacterial, and protozoal causation. Considerable overlap exists between each of the etiologic groups in the spectrum of pathologic alterations seen in the myocardium. These include various degenerative changes, myocyte necrosis, and inflammatory lesions. However, some diseases show rather characteristic myocardial alterations such as vacuolar degeneration in anthracycline cardiotoxicity, myofibrillar lysis in furazolidone cardiotoxicity, calcification in calcinosis of mice, glycogen accumulation in the glycogenoses, lipofuscinosis in cattle, fatty degeneration in erucic acid cardiotoxicity, myofiber disarray in hypertrophic cardiomyopathy, and lymphocytic inflammation with inclusion bodies in canine parvoviral myocarditis. The myocardial diseases represent the largest group in the spectrum of spontaneous cardiac diseases of animals. Pericardial and endocardial diseases and congential cardiac diseases are seen less frequently; and, in contrast to man, coronary artery disease and myocardial ischemia are rather infrequent in animals. The present review shows clearly that the spectrum of myocardial diseases in animals is enlarging and that many newly recognized diseases are emerging and assuming considerable importance. For example, various heritable cardiomyopathies have recently been described in the KK mouse, cattle, and rats. Increasingly recognized myocardial diseases include cardiomyopathies in cats, dogs, and birds; anthracycline cardiotoxicity; furazolidone cardiotoxicity; ionophore cardiotoxicity; myocardial damage associated with central nervous system injuries; myocardial hypertrophy in PMID:3524254

  19. Intake of hot water-extracted apple protects against myocardial injury by inhibiting apoptosis in an ischemia/reperfusion rat model.

    PubMed

    Kim, Mi Young; Lim, Sun Ha; Lee, Jongwon

    2014-11-01

    Intakes of apple and its products are shown to reduce the risk of coronary heart disease by delaying occlusion of coronary arteries. In our previous study, we showed that apple pectin protected against myocardial injury by prohibiting apoptotic cascades in a rat model of ischemia/reperfusion. Thus, we hypothesized that water-extracted apple, into which apple pectin was released from the cell wall, might exhibit the same efficacy as apple pectin. To test this hypothesis, we fed rats either cold water- (400 mg kg(-1) d(-1)) or hot water-extracted apples (HWEA; 40, 100, and 400 mg kg(-1) d(-1)). Three days later, the rats were subjected to myocardial injuries by ligating the left anterior descending coronary artery (30 minutes), and subsequently, the heart (3 hours) reperfused by releasing the ligation. Only the rats that were supplemented with HWEA (400 mg kg(-1) d(-1)) showed significant reductions in infarct size, which was 28.5% smaller than that of the control group. This infarct size reduction could be partly attributed to the prevention of steps leading to apoptosis. These steps are manifested by a higher Bcl-2/Bax ratio, lower procaspase-3 conversion to caspase-3, and inhibition of DNA nick generation, which reflects the extent of apoptosis. The findings indicate that HWEA supplementation reduces myocardial injury by inhibiting apoptosis under ischemia/reperfusion conditions. In conclusion, this study suggests that apple intake, specifically boiled apple, might reduce the risk of coronary heart disease by inhibiting postocclusion steps, such as myocardial injury after artery occlusion, as well as preocclusion steps, such as atherosclerotic plaque formation. PMID:25304826

  20. Microvascular obstruction after successful fibrinolytic therapy in acute myocardial infarction. Comparison of reteplase vs reteplase+abciximab: A cardiovascular magnetic resonance study

    PubMed Central

    ZONI, ANTONELLO; KNOLL, PETER; GHERLI, TIZIANO

    2006-01-01

    Background. About one third of patients with TIMI 3 after reperfusion have evidence of microvascular obstruction (MO) which represents an independent predictor of myocardial wall rupture. This explains all efforts made to prevent MO. Magnetic resonance imaging (MRI) has proved to be particularly useful in detecting MO. The aim of this study was to evaluate with MRI if different fibrinolytic regimens in acute myocardial infarction display different effects on left ventricle (LV) volumes and ejection fraction (EF), as well as on myocardial infarct size (MIsz) and MO. Methods. Twenty male patients, mean age 58 years, affected by acute myocardial infarction, ten anterior and ten inferior, were treated with: full dose reteplase in ten, and half dose reteplase plus full dose abciximab (R+Abcx) in the other ten patients. In the fourth day after hospital admission, MRI STIR T2 images were used to quantify MIsz, while 2dflash cineloops were used after the injection of gadolinium, to quantify LV volumes, EF and to detect MO. Results. LV EF was higher in R+Abcx 51±10 than in reteplase 41±8. MIsz was similar in both treatment groups: however a close relationship was present between MIsz and EF in the reteplase group indicating that the greater the MIsz the lower the EF. In R+Abcx this relationship was no longer present, suggesting a protective effect of the drug on microcirculation. In fact extensive MO was present in 25% of all cases, 80% of which in the reteplase group while only 20% in R+Abcx. Conclusion. R+Abcx prevents MO: compared to traditional fibrinolytic therapy it allows better LV function and most likely improved long term survival. PMID:21977252

  1. Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.

    PubMed

    Lev, Eli I; Kornowski, Ran; Vaknin-Assa, Hana; Porter, Avital; Teplitsky, Igal; Ben-Dor, Itsik; Brosh, David; Fuchs, Shmuel; Battler, Alexander; Assali, Abid

    2008-07-01

    Accurate risk stratification has an important role in the management of patients with acute coronary syndromes. Even in patients with ST-elevation acute myocardial infarction (STEMI), for whom early therapeutic options are well defined, risk stratification has an impact on early and late therapeutic decision making. We aimed to compare the prognostic value of 4 risk scores used to evaluate patients with STEMI. We conducted a prospective registry of all patients treated with primary percutaneous coronary intervention for STEMI from January 2001 to June 2006. Excluded were patients with cardiogenic shock. A total of 855 consecutive patients were included in the analysis (age 60.5 +/- 13 years, 19% women, 28% with diabetes, and 48% with anterior wall myocardial infarction). For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) risk scores were calculated using specific clinical variables and angiographic characteristics. Thirty-day and 1-year clinical outcomes were assessed. The predictive accuracy of the 4 risk scores was evaluated using the area under the curve or C statistic method. The CADILLAC, TIMI, and PAMI risk scores all had relatively high predictive accuracy for 30-day and 1-year mortality (C statistic range 0.72 to 0.82), with slight superiority of the CADILLAC score. These 3 risk scores also performed well for prediction of reinfarction at 30 days (C statistic range 0.6 to 0.7). The GRACE score did not perform as well and had low predictive accuracy for mortality (C statistic 0.47). In conclusion, risk stratification of patients with STEMI undergoing primary percutaneous coronary intervention using the CADILLAC, TIMI, or PAMI risk scores provide important prognostic information and enables accurate identification of high-risk patients. PMID:18572028

  2. Mitral stenosis and acute ST elevation myocardial infarction.

    PubMed

    Cardoz, Joseph; Jayaprakash, K; George, Raju

    2015-04-01

    We describe a patient who presented with acute (inferior wall) ST elevation myocardial infarction. Her echocardiogram showed severe mitral stenosis with ball valve thrombus in the left atrial body and thrombus in the left atrial appendage. Coronary angiogram revealed thromboembolic material in the right coronary artery. Mitral valve replacement was scheduled. PMID:25829656

  3. A randomized double-blind control study of early intra-coronary autologous bone marrow cell infusion in acute myocardial infarction: the REGENERATE-AMI clinical trial†

    PubMed Central

    Choudry, Fizzah; Hamshere, Stephen; Saunders, Natalie; Veerapen, Jessry; Bavnbek, Katrine; Knight, Charles; Pellerin, Denis; Locca, Didier; Westwood, Mark; Rakhit, Roby; Crake, Tom; Kastrup, Jens; Parmar, Mahesh; Agrawal, Samir; Jones, Daniel; Martin, John; Mathur, Anthony

    2016-01-01

    Aims Clinical trials suggest that intracoronary delivery of autologous bone marrow-derived cells (BMCs) 1–7 days post-acute myocardial infarction (AMI) may improve left ventricular (LV) function. Earlier time points have not been evaluated. We sought to determine the effect of intracoronary autologous BMC on LV function when delivered within 24 h of successful reperfusion therapy. Methods and results A multi-centre phase II randomized, double-blind, and placebo-controlled trial. One hundred patients with anterior AMI and significant regional wall motion abnormality were randomized to receive either intracoronary infusion of BMC or placebo (1:1) within 24 h of successful primary percutaneous intervention (PPCI). The primary endpoint was the change in left ventricular ejection fraction (LVEF) between baseline and 1 year as determined by advanced cardiac imaging. At 1 year, although LVEF increased compared with baseline in both groups, the between-group difference favouring BMC was small (2.2%; 95% confidence interval, CI: −0.5 to 5.0; P = 0.10). However, there was a significantly greater myocardial salvage index in the BMC-treated group compared with placebo (0.1%; 95% CI: 0.0–0.20; P = 0.048). Major adverse events were rare in both treatment groups. Conclusion The early infusion of intracoronary BMC following PPCI for patients with AMI and regional wall motion abnormality leads to a small non-significant improvement in LVEF when compared with placebo; however, it may play an important role in infarct remodelling and myocardial salvage. Clinical trial registration Clinicaltrials.gov NCT00765453 and EudraCT 2007-002144-16. PMID:26405233

  4. Myocardial stunning in hypertrophic cardiomyopathy: recovery predicted by single photon emission computed tomographic thallium-201 scintigraphy

    SciTech Connect

    Fine, D.G.; Clements, I.P.; Callahan, M.J.

    1989-05-01

    A young woman with hypertrophic cardiomyopathy confirmed by echocardiography and cardiac catheterization presented with chest pain and features of a large left ventricular aneurysm. The initial diagnosis was myocardial ischemia with either an evolving or an ancient myocardial infarction. Subsequently, verapamil therapy was associated with complete resolution of the extensive left ventricular wall motion abnormalities, normalization of left ventricular ejection fraction and a minimal myocardial infarction. Normal thallium uptake on single photon emission computed tomographic scintigraphy early in the hospital course predicted myocardial viability in the region of the aneurysm. Thus, orally administered verapamil may reverse spontaneous extensive myocardial ischemia in hypertrophic cardiomyopathy and possibly limit the extent of myocardial infarction in such circumstances.

  5. Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis

    SciTech Connect

    Alexander, E.L.; Firestein, G.S.; Weiss, J.L.; Heuser, R.R.; Leitl, G.; Wagner, H.N. Jr.; Brinker, J.A.; Ciuffo, A.A.; Becker, L.C.

    1986-11-01

    The effects of peripheral cold exposure on myocardial perfusion and function were studied in 13 patients with scleroderma without clinically evident myocardial disease. Ten patients had at least one transient, cold-induced, myocardial perfusion defect visualized by thallium-201 scintigraphy, and 12 had reversible, cold-induced, segmental left ventricular hypokinesis by two-dimensional echocardiography. The 10 patients with transient perfusion defects all had anatomically corresponding ventricular wall motion abnormalities. No one in either of two control groups (9 normal volunteers and 7 patients with chest pain and normal coronary arteriograms) had cold-induced abnormalities. This study is the first to show the simultaneous occurrence of cold-induced abnormalities in myocardial perfusion and function in patients with scleroderma. The results suggest that cold exposure in such patients may elicit transient reflex coronary vasoconstriction resulting in reversible myocardial ischemia and dysfunction. Chronic recurrent episodes of coronary spasm may lead to focal myocardial fibrosis.

  6. Photoacoustic microscopy of myocardial sheet architecture in unfixed and unstained mammalian hearts

    NASA Astrophysics Data System (ADS)

    Zhang, Chi; Cheng, Ya-Jian; Yao, Da-Kang; Wickline, Samuel; Wang, Lihong V.

    2012-02-01

    The laminar myocardial sheet architecture and its dynamic change play a key role in myocardial wall thickening. Histology, confocal optical microscopy (COM), and diffusion tensor MRI (DTI) have been used to unveil the structures and functions of the myocardial sheets. However, histology and COM require fixation, sectioning, and staining processes, which dehydrate and deform the sheet architecture. Although DTI can delineate sheet architecture nondestructively in viable hearts, it cannot provide cellular-level resolution. Here we show that photoacoustic microscopy (PAM), with high resolution (~1 μm) and label-free detection, is appropriate for imaging 3D myocardial architecture. Perfused half-split mouse hearts were also imaged by PAM in vitro without fixation, dehydration, nor staining. The laminar myocardial sheet architecture was clearly visualized within a 0.15 mm depth range. Two populations of oppositely signed sheet angles were observed. Therefore, PAM promises to access dynamic changes of myocardial architectures in ex vivo perfused-viable hearts.

  7. Painless acute myocardial infarction on Mount Kilimanjaro.

    PubMed

    Jamal, Nasiruddin; Rajhy, Mubina; Bapumia, Mustaafa

    2016-01-01

    An individual experiencing dyspnoea or syncope at high altitude is commonly diagnosed to have high-altitude pulmonary edema or cerebral edema. Acute myocardial infarction (AMI) is generally not considered in the differential diagnosis. There have been very rare cases of AMI reported only from Mount Everest. We report a case of painless ST segment elevation myocardial infarction (STEMI) that occurred while climbing Mount Kilimanjaro. A 51-year-old man suffered dyspnoea and loss of consciousness near the mountain peak, at about 5600 m. At a nearby hospital, he was treated as a case of high-altitude pulmonary edema. ECG was not obtained. Two days after the incident, he presented to our institution with continued symptoms of dyspnoea, light-headedness and weakness, but no pain. He was found to have inferior wall and right ventricular STEMI complicated by complete heart block. He was successfully managed with coronary angioplasty, with good recovery. PMID:26989121

  8. systolic flow augmentation in hearts ejecting into a model of stiff aging vasculature. Influence on myocardial perfusion-demand balance.

    PubMed

    Saeki, A; Recchia, F; Kass, D A

    1995-01-01

    Age-related arterial stiffening and widening of the pulse pressure elevates ventricular systolic wall stress while it lowers diastolic coronary perfusion pressure. These changes are thought to adversely alter the balance between myocardial work load and blood supply. To test this hypothesis, the native compliant thoracic aorta was surgically bypassed by a stiff tube in reflex-blocked anesthetized dogs. Ventricular outflow was directed into either native aorta or the bypass; the latter resulting in an increase in arterial pulse pressure from 37.8 to 107.5 mm Hg (P < .001), with minimal change in mean pressure and flow. Cardiac work load was assessed by pressure-volume area (PVA), which combines external and internal left ventricular work and is linearly related to myocardial oxygen consumption (MVO2), and by MVO2 itself. Regional phasic and mean coronary flow were measured in the left anterior descending coronary artery, and global flow was assessed by radiolabeled microspheres. Myocardial supply-demand balance was assessed by comparing flow at matched PVA or MVO2, flow-PVA relations, and endocardial-to-epicardial flow ratios. When blood flow was directed into the stiff bypass tube, peak systolic pressure, wall stress, and PVA all rose nearly 50%, yet diastolic perfusion pressure fell by 20 mm Hg (all P < .01). Rather than being compromised, however, mean coronary flow rose by 34%, maintaining the same endocardial-to-epicardial flow ratio (approximately 1.1). Flow augmentation persisted when data were compared at matched work load (PVA or MVO2), and mean arterial pressure, as well as over a range of work loads (P < .001 from ANCOVA of flow-PVA relations). The increased flow resulted from enhanced systolic perfusion, which nearly equaled diastolic flow when ejection passed into the stiff bypass. These data counter the notion that cardiac coupling with a stiff arterial system (as with aging) necessarily compromises myocardial flow versus metabolic demand. However, the data highlight a greater role of systolic flow under such conditions and also raise the novel suggestion that enhanced pulsatility of the arterial pressure waveform may itself augment coronary perfusion. PMID:8001271

  9. Abdominal Wall Schwannoma: Case Report and Review of the Literature

    PubMed Central

    Mishra, A.; Hamadto, M.; Azzabi, M.; Elfagieh, M.

    2013-01-01

    A 29-year-old female had presented to surgical outpatient's department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised, and histopathology confirmed it to be “ancient” schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. PMID:23841008

  10. Effect of hydroxy safflower yellow A on myocardial apoptosis after acute myocardial infarction in rats.

    PubMed

    Zhou, M X; Fu, J H; Zhang, Q; Wang, J Q

    2015-01-01

    This study aimed to investigate the effect of hydroxy safflower yellow A (HSYA) on myocardial apoptosis after acute myocardial infarction (AMI) in rats. We randomly divided 170 male Wistar rats into 6 groups (N = 23): normal control, sham, control, SY (90 mg/kg), HSYA high-dose (HSYA-H, 40 mg/kg), and HSYA low-dose groups (HSYA-L, 20 mg/kg). Myocardial ischemic injury was induced by ligating the anterior descending coronary artery, and the degree of myocardial ischemia was evaluated using electrocardiography and nitroblue tetrazolium staining. Bax and Bcl-2 expressions in the ischemic myocardium were determined using immunohistochemical analysis. Peroxisome proliferator-activated receptor-γ (PPAR-γ) expression in the myocardium of rats with AMI was determined using reverse transcription-polymerase chain reaction. Compared to rats in the control group, those in the HYSA-H, HSYA-L, and SY groups showed a decrease in the elevated ST segments and an increase in the infarct size. The rats in the drug-treated groups showed a significantly lower percentage of Bax-positive cells and a significantly higher percentage of Bcl-2-positive cells than those in the control group (P < 0.05). Moreover, mRNA expression of PPAR-γ in the ischemic myocardium of rats in the SY, HSYA-L, and HSYA-H groups was significantly lower than that in the control group (P < 0.05). Thus, HSYA and SY can attenuate myocardial ischemia in rats, possibly by increasing the level of Bcl-2/Bax, and PPAR-γ may be not a necessary link in this process. PMID:25966078

  11. Intraprocedural myocardial contrast echocardiography as a routine procedure in percutaneous transluminal septal myocardial ablation: detection of threatening myocardial necrosis distant from the septal target area.

    PubMed

    Faber, L; Seggewiss, H; Ziemssen, P; Gleichmann, U

    1999-08-01

    Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative to surgery for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Visualization of the ablation area prior to induction of the chemical necrosis is possible by intraprocedural myocardial contrast echocardiography (MCE). We report on two patients in whom MCE showed opacification of the medial papillary muscle or the left ventricular posterolateral free wall. In both patients the correct ablation area could be identified by MCE after a change of the target vessel, thus avoiding potentially fatal complications due to induction of a necrosis of myocardium distant from the septal target area. PMID:10470478

  12. Myocardial Viability and Impact of Surgical Ventricular Reconstruction on Outcomes of Patients with Severe Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery: Results of the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

    PubMed Central

    Holly, Thomas A.; Bonow, Robert O.; Arnold, J. Malcolm O.; Oh, Jae K.; Varadarajan, Padmini; Pohost, Gerald M.; Haddad, Haissam; Jones, Robert H.; Velazquez, Eric J.; Birkenfeld, Bozena; Asch, Federico M.; Malinowski, Marcin; Barretto, Rodrigo; Kalil, Renato A.K.; Berman, Daniel S.; Sun, Jie-Lena; Lee, Kerry L.; Panza, Julio A.

    2014-01-01

    Objective In the Surgical Treatment for Ischemic Heart Failure (STICH) trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared to bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared to bypass alone. Methods Myocardial viability was assessed by single photon computed tomography in 267 of the 1,000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in STICH. Myocardial viability was assessed on a per patient basis as well as regionally based on pre-specified criteria. Results At 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and those without viability, and there was no significant interaction between the type of surgery and global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality. Conclusion In patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery. PMID:25152476

  13. Anterior interosseous nerve syndrome

    PubMed Central

    Bäumer, Philipp; Meinck, Hans-Michael; Schiefer, Johannes; Weiler, Markus; Bendszus, Martin; Kele, Henrich

    2014-01-01

    Objective: We sought to determine lesion sites and spatial lesion patterns in spontaneous anterior interosseous nerve syndrome (AINS) with high-resolution magnetic resonance neurography (MRN). Methods: In 20 patients with AINS and 20 age- and sex-matched controls, MRN of median nerve fascicles was performed at 3T with large longitudinal anatomical coverage (upper arm/elbow/forearm): 135 contiguous axial slices (T2-weighted: echo time/repetition time 52/7,020 ms, time of acquisition: 15 minutes 48 seconds, in-plane resolution: 0.25 × 0.25 mm). Lesion classification was performed by visual inspection and by quantitative analysis of normalized T2 signal after segmentation of median nerve voxels. Results: In all patients and no controls, T2 lesions of individual fascicles were observed within upper arm median nerve trunk and strictly followed a somatotopic/internal topography: affected were those motor fascicles that will form the anterior interosseous nerve further distally while other fascicles were spared. Predominant lesion focus was at a mean distance of 14.6 ± 5.4 cm proximal to the humeroradial joint. Discriminative power of quantitative T2 signal analysis and of qualitative lesion rating was high, with 100% sensitivity and 100% specificity (p < 0.0001). Fascicular T2 lesion patterns were rated as multifocal (n = 17), monofocal (n = 2), or indeterminate (n = 1) by 2 independent observers with strong agreement (kappa = 0.83). Conclusion: It has been difficult to prove the existence of fascicular/partial nerve lesions in spontaneous neuropathies using clinical and electrophysiologic findings. With MRN, fascicular lesions with strict somatotopic organization were observed in upper arm median nerve trunks of patients with AINS. Our data strongly support that AINS in the majority of cases is not a surgically treatable entrapment neuropathy but a multifocal mononeuropathy selectively involving, within the main trunk of the median nerve, the motor fascicles that continue distally to form the anterior interosseous nerve. PMID:24415574

  14. Evaluating anterior knee pain.

    PubMed

    Hong, Engene; Kraft, Michael C

    2014-07-01

    Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider. There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition as well as key points. PMID:24994047

  15. Magnetic targeting enhances retrograde cell retention in a rat model of myocardial infarction

    PubMed Central

    2013-01-01

    Introduction Retrograde coronary venous infusion is a promising delivery method for cellular cardiomyoplasty. Poor cell retention is the major obstacle to the establishment of this method as the preferred route for cell delivery. Here, we explored whether magnetic targeting could enhance retrograde cell retention in a rat model of myocardial infarction. Methods Rat mesenchymal stem cells were labeled with superparamagnetic oxide nanoparticles. The magnetic responsiveness of MSCs was observed while cells flowed through a tube that served as a model of blood vessels in a 0.6-Tesla magnetic field. In a Sprague–Dawley rat model of acute myocardial infarction, 1 × 106 magnetic mesenchymal stem cells were transjugularly injected into the left cardiac vein while a 0.6-Tesla magnet was placed above the heart. The cardiac retention of transplanted cells was assessed by using quantitative Y chromosome-specific polymerase chain reaction, cardiac magnetic resonance imaging, and optical imaging. Cardiac function was measured by using echocardiography, and histologic analyses of infarct morphology and angiogenesis were obtained. Results The flowing iron oxide-labeled mesenchymal stem cells were effectively attracted to the area where the magnet was positioned. Twenty-four hours after cellular retrocoronary delivery, magnetic targeting significantly increased the cardiac retention of transplanted cells by 2.73- to 2.87-fold. Histologic analyses showed that more transplanted cells were distributed in the anterior wall of the left ventricle. The enhanced cell engraftment persisted for at least 3 weeks, at which time, left ventricular remodeling was attenuated, and cardiac function benefit was improved. Conclusions These results suggest that magnetic targeting offers new perspectives for retrograde coronary venous delivery to enhance cell retention and subsequent functional benefit in heart diseases. PMID:24330751

  16. Regional cardiac adrenergic function using I-123 meta-iodobenzylguanidine tomographic imaging after acute myocardial infarction

    SciTech Connect

    McGhie, A.I.; Corbett, J.R.; Akers, M.S.; Kulkarni, P.; Sills, M.N.; Kremers, M.; Buja, L.M.; Durant-Reville, M.; Parkey, R.W.; Willerson, J.T. )

    1991-02-01

    The effect of acute myocardial infarction (AMI) on regional cardiac adrenergic function was studied in 27 patients mean +/- standard deviation 10 +/- 4 days after AMI. Regional adrenergic function was evaluated noninvasively with I-123 meta-iodobenzylguanidine (MIBG) using a dedicated 3-detector tomograph. Four hours after its administration, there was reduced MIBG uptake in the region of infarction, 0.38 +/- 0.31 counts/pixel/mCi x 103 compared with 0.60 +/- 0.30 counts/pixel/mCi x 103 and 0.92 +/- 0.35 counts/pixel/mCi x 103 in the zones bordering and distant from the infarct area, respectively, p less than 0.001. In all patients, the area of reduced MIBG uptake after 4 hours was more extensive that the associated thallium-201 perfusion defect with defect scores of 52 +/- 22 and 23 +/- 18%, respectively, p less than 0.001. After anterior wall AMI, the 4-hour MIBG defect score was 70 +/- 13% and the degree of mismatch between myocardial perfusion and MIBG uptake was 30 +/- 9% compared with 39 +/- 17 and 21 +/- 17% after inferior AMI, p less than 0.001 and p = 0.016, respectively. The 4-hour MIBG defect score correlated inversely with the predischarge left ventricular ejection fraction, r = -0.73, p less than 0.001. Patients with ventricular arrhythmia of greater than or equal to 1 ventricular premature complexes per hour, paired ventricular premature complexes or ventricular tachycardia detected during the late hospital phase had higher 4-hour MIBG defect scores, 62.5 +/- 15.0%, than patients with no detectable complex ventricular ectopic activity and a ventricular premature complex frequency of less than 1 per hour, 44.6 +/- 23.4%, p = 0.036.

  17. Anterior Shoulder Dislocation

    PubMed Central

    Cutts, Steven; Prempeh, Mark; Drew, Steven

    2009-01-01

    INTRODUCTION Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management. MATERIALS AND METHODS We have discussed this condition with our colleagues and performed a Medline search (‘anterior shoulder dislocation’) of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint. RESULTS Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition. CONCLUSIONS Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae. PMID:19126329

  18. Myocardial Lineage Development

    PubMed Central

    Evans, Sylvia M.; Yelon, Deborah; Conlon, Frank L.; Kirby, Margaret L.

    2010-01-01

    The myocardium of the heart is composed of multiple highly specialized myocardial lineages, including those of the ventricular and atrial myocardium, and the specialized conduction system. Specification and maturation of each of these lineages during heart development is a highly ordered, ongoing process involving multiple signaling pathways and their intersection with transcriptional regulatory networks. Here, we attempt to summarize and compare much of what we know about specification and maturation of myocardial lineages from studies in several different vertebrate model systems. To date, most research has focused on early specification, and while there is still more to learn, less is known about factors that promote subsequent maturation of myocardial lineages required to build the functioning adult heart. PMID:21148449

  19. ECG findings after myocardial infarction in children after Kawasaki disease

    SciTech Connect

    Nakanishi, T.; Takao, A.; Kondoh, C.; Nakazawa, M.; Hiroe, M.; Matsumoto, Y.

    1988-10-01

    Standard 12-lead ECGs were evaluated in 17 children with myocardial infarction and 78 children without myocardial infarction after Kawasaki disease; sensitivity and specificity of the ECG infarction criteria were determined. The presence or absence of myocardial infarction was determined from either clinical examination results (coronary angiography, ventriculography, and thallium-201 myocardial imaging) or autopsy findings. Of seven patients with inferior infarction, abnormally deep Q waves in lead II, III, or aVF were observed in six, but the duration was greater than 0.04 second in only one (14%). The sensitivity and specificity of inferior infarction criteria based on Q wave amplitude were 86% and 97%, respectively. Of eight patients with anterior infarction, seven (88%) had abnormally deep and wide (greater than or equal to 0.04 second) Q waves in anterior chest leads. The sensitivity and specificity of the infarction criteria based on the amplitude and duration of the Q wave were 75% and 99%, respectively. Of seven patients with lateral infarction, Q waves were observed in lead I, aVL, or both in four patients, and in all of these patients Q waves were wider than 0.04 second. In two patients with both inferior and anterior infarction, Q waves were observed only in leads II, III, and aVF; in only one patient were the Q waves wider than 0.04 second. Thus deep Q waves in lead II, III, or aVF that are not wider than 0.04 second may indicate inferior infarction in children. Q waves in lead I, aVL, and chest leads associated with anterolateral infarction are in most instances deep and wide.

  20. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.

  1. Acute myocardial infarction associated with intravenous dipyridamole for rubidium-82 PET imaging

    SciTech Connect

    Marwick, T.H.; Hollman, J. )

    1990-03-01

    This report describes the occurrence of chest pain and electrocardiographic features of acute myocardial infarction following intravenous dipyridamole-handgrip stress. Myocardial perfusion imaging (Rb-82 PET) demonstrated a stress-induced perfusion defect. Following failure to respond to medical therapy, urgent cardiac catheterization demonstrated total occlusion of the left anterior descending coronary artery. The vessel was revascularized, with limitation of myocardial damage evidenced by failure to develop anterior Q waves and only modest elevation of cardiac enzyme levels. Complications of intravenous dipyridamole stress are rare, this case constituting the first major problem in over 500 such procedures at this institution. However, this experience demonstrates the importance of vigilant observation during the performance of this technique.

  2. 3D perfusion mapping in the intact mouse heart after myocardial infarction using myocardial contrast echocardiography

    NASA Astrophysics Data System (ADS)

    Li, Yinbo; Yang, Zequan; French, Brent A.; Hossack, John A.

    2005-04-01

    An intact mouse model of surgically-induced myocardial infarction (MI) caused by permanent occlusion of the Left Anterior Descending (LAD) coronary artery was studied. Normal mice with no occlusion were also studied as controls. For each mouse, contrast enhanced ultrasound images of the heart were acquired in parallel cross-sections perpendicular to the sternum at millimeter increments. For accurate 3D reconstruction, ECG gating and a tri-axial adjustable micromanipulator were used for temporal and spatial registration. Ultrasound images at steady-state of blood refilling were color-coded in each slice to show relative perfusion. Myocardial perfusion defects and necrosis were also examined postmortem by staining with Phthalo blue and TTC red dyes. Good correlation (R>0.93) in perfused area size was observed between in vivo measurements and histological staining. A 3D multi-slice model and a 3D rendering of perfusion distribution were created and showed a promising match with postmortem results, lending further credence to its use as a more comprehensive and more reliable tool for in vivo assessment of myocardial perfusion than 2D tomographic analysis.

  3. Lidocaine Enhances Contractile Function of Ischemic Myocardial Regions in Mouse Model of Sustained Myocardial Ischemia

    PubMed Central

    Kania, Gabriela; Osto, Elena; Jakob, Philipp; Krasniqi, Nazmi; Beck-Schimmer, Beatrice; Blyszczuk, Przemyslaw; Eriksson, Urs

    2016-01-01

    Rationale Perioperative myocardial ischemia is common in high-risk patients. The use of interventional revascularisation or even thrombolysis is limited in this patient subset due to exceedingly high bleeding risks. Blockade of voltage-gated sodium channels (VGSC) with lidocaine had been suggested to reduce infarct size and cardiomyocyte cell death in ischemia/reperfusion models. However, the impact of lidocaine on cardiac function during sustained ischemia still remains unclear. Methods Sustained myocardial ischemia was induced by ligation of the left anterior descending artery in 12–16 weeks old male BALB/c mice. Subcutaneous lidocaine (30 mg/kg) was used to block VGSC. Cardiac function was quantified at baseline and at 72h by conventional and speckle-tracking based echocardiography to allow high-sensitivity in vivo phenotyping. Infarct size and cardiomyocyte cell death were assessed post mortem histologically and indirectly using troponin measurements. Results Ischemia strongly impaired both, global systolic and diastolic function, which were partially rescued in lidocaine treated in mice. No differences regarding infarct size and cardiomyocyte cell death were observed. Mechanistically, and as shown with speckle-tracking analysis, lidocaine specifically improves residual contractility in the ischemic but not in the remote, non-ischemic myocardium. Conclusion VGSC blockade with lidocaine rescues function of ischemic myocardium as a potential bridging to revascularisation in the setting of perioperative myocardial ischemia. PMID:27140425

  4. Bone marrow mesenchymal stem cells improve myocardial function in a swine model of acute myocardial infarction.

    PubMed

    Zhao, Jing-Jie; Liu, Xiao-Cheng; Kong, Feng; Qi, Tong-Gang; Cheng, Guang-Hui; Wang, Jue; Sun, Chao; Luan, Yun

    2014-09-01

    The aim of the current study was to confirm the effect and elucidate the mechanism of bone marrow mesenchymal stem cells (BMSCs) in acute myocardial infarction (AMI). AMI was induced in mini‑swine by ligating the left anterior descending coronary artery, and BMSCs (1x107) were injected via a sterile microinjection into the ischemic area. Six months postoperatively, electrocardiograph‑gated single photon emission computed tomography revealed that the myocardial filling defect was reduced and the left ventricular ejection fraction was improved in the BMSC group compared with the control group (P<0.05). Histopathological examination indicated that, in the BMSC treatment group, the percentage of survived myocardial tissue and the vessel density were increased, and the percentage of apoptosis was decreased compared with controls (P<0.05). Reverse transcription‑polymerase chain reaction results indicated that the expression levels of multiple inflammatory factors were significantly upregulated in the BMSC group compared with levels in the control group (P<0.05). In conclusion, the present study demonstrated that BMSC injection significantly improved cardiac function and reduced infarct size in six months, indicating that this method may be valuable for future study in clinical trials. PMID:25060678

  5. Leukocyte behavior in atherosclerosis, myocardial infarction, and heart failure

    PubMed Central

    Swirski, Filip K.; Nahrendorf, Matthias

    2013-01-01

    Cardiovascular diseases claim more lives worldwide than any other. Etiologically, the dominant trajectory involves atherosclerosis, a chronic inflammatory process of lipid-rich lesion growth in the vascular wall that can cause life-threatening myocardial infarction (MI). Those who survive MI can develop congestive heart failure, a chronic condition of inadequate pump activity that is frequently fatal. Leukocytes – white blood cells – are important participants at the various stages of cardiovascular disease progression and complication. This review will discuss leukocyte function in atherosclerosis, myocardial infarction, and heart failure. PMID:23307733

  6. Sustained-Release Delivery of Prostacyclin Analogue Enhances Bone Marrow-Cell Recruitment and Yields Functional Benefits for Acute Myocardial Infarction in Mice

    PubMed Central

    Imanishi, Yukiko; Miyagawa, Shigeru; Fukushima, Satsuki; Ishimaru, Kazuhiko; Sougawa, Nagako; Saito, Atsuhiro; Sakai, Yoshiki; Sawa, Yoshiki

    2013-01-01

    Background A prostacyclin analogue, ONO-1301, is reported to upregulate beneficial proteins, including stromal cell derived factor-1 (SDF-1). We hypothesized that the sustained-release delivery of ONO-1301 would enhance SDF-1 expression in the acute myocardial infarction (MI) heart and induce bone marrow cells (BMCs) to home to the myocardium, leading to improved cardiac function in mice. Methods and Results ONO-1301 significantly upregulated SDF-1 secretion by fibroblasts. BMC migration was greater to ONO-1301-stimulated than unstimulated conditioned medium. This increase was diminished by treating the BMCs with a CXCR4-neutralizing antibody or CXCR4 antagonist (AMD3100). Atelocollagen sheets containing a sustained-release form of ONO-1301 (n = 33) or ONO-1301-free vehicle (n = 48) were implanted on the left ventricular (LV) anterior wall immediately after permanent left-anterior descending artery occlusion in C57BL6/N mice (male, 8-weeks-old). The SDF-1 expression in the infarct border zone was significantly elevated for 1 month in the ONO-1301-treated group. BMC accumulation in the infarcted hearts, detected by in vivo imaging after intravenous injection of labeled BMCs, was enhanced in the ONO-1301-treated hearts. This increase was inhibited by AMD3100. The accumulated BMCs differentiated into capillary structures. The survival rates and cardiac function were significantly improved in the ONO-1301-treated group (fractional area change 23±1%; n = 22) compared to the vehicle group (19±1%; n = 20; P = 0.004). LV anterior wall thinning, expansion of infarction, and fibrosis were lower in the ONO-1301-treated group. Conclusions Sustained-release delivery of ONO-1301 promoted BMC recruitment to the acute MI heart via SDF-1/CXCR4 signaling and restored cardiac performance, suggesting a novel mechanism for ONO-1301-mediated acute-MI heart repair. PMID:23894446

  7. Myocardial diseases of animals.

    PubMed Central

    Van Vleet, J. F.; Ferrans, V. J.

    1986-01-01

    In this review we have attempted a comprehensive compilation of the cardiac morphologic changes that occur in spontaneous and experimental myocardial diseases of animals. Our coverage addresses diseases of mammals and birds and includes these diseases found in both domesticated and wild animals. A similar review of the myocardial diseases in this broad range of animal species has not been attempted previously. We have summarized and illustrated the gross, microscopic, and ultrastructural alterations for these myocardial diseases; and, whenever possible, we have reviewed their biochemical pathogenesis. We have arranged the myocardial diseases for presentation and discussion according to an etiologic classification with seven categories. These include a group of idiopathic or primary cardiomyopathies recognized in man (hypertrophic, dilated, and restrictive types) and a large group of secondary cardiomyopathies with known causes, such as inherited tendency; nutritional deficiency; toxicity; physical injury and shock; endocrine disorders, and myocarditides of viral, bacterial, and protozoal causation. Considerable overlap exists between each of the etiologic groups in the spectrum of pathologic alterations seen in the myocardium. These include various degenerative changes, myocyte necrosis, and inflammatory lesions. However, some diseases show rather characteristic myocardial alterations such as vacuolar degeneration in anthracycline cardiotoxicity, myofibrillar lysis in furazolidone cardiotoxicity, calcification in calcinosis of mice, glycogen accumulation in the glycogenoses, lipofuscinosis in cattle, fatty degeneration in erucic acid cardiotoxicity, myofiber disarray in hypertrophic cardiomyopathy, and lymphocytic inflammation with inclusion bodies in canine parvoviral myocarditis. The myocardial diseases represent the largest group in the spectrum of spontaneous cardiac diseases of animals. Pericardial and endocardial diseases and congential cardiac diseases are seen less frequently; and, in contrast to man, coronary artery disease and myocardial ischemia are rather infrequent in animals. The present review shows clearly that the spectrum of myocardial diseases in animals is enlarging and that many newly recognized diseases are emerging and assuming considerable importance. For example, various heritable cardiomyopathies have recently been described in the KK mouse, cattle, and rats. Increasingly recognized myocardial diseases include cardiomyopathies in cats, dogs, and birds; anthracycline cardiotoxicity; furazolidone cardiotoxicity; ionophore cardiotoxicity; myocardial damage associated with central nervous system injuries; myocardial hypertrophy in Images Figure 1 Figure 2 Figure 45 Figure 46 Figure 47 Figure 48 Figure 61 Figure 62 Figure 63 Figure 64 Figure 79 Figure 75 Figure 76 Figure 77 Figure 78 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 Figure 27 Figure 28 Figure 29 & 30 Figure 31 Figure 32 Figure 33 Figure 34 Figure 35 Figure 36 Figure 37 Figure 38 Figure 39 Figure 40 Figure 41 Figure 42 Figure 43 Figure 44 Figure 49 Figure 50 Figure 51 Figure 52 Figure 53 Figure 54 Figure 55 Figure 56 Figure 57 Figure 58 Figure 59 Figure 60 Figure 65 Figure 66 Figure 67 Figure 68 Figure 69 Figure 70 Figure 71 & 72 Figure 73 & 74 PMID:3524254

  8. Wall turbulence without walls

    NASA Astrophysics Data System (ADS)

    Mizuno, Yoshinori; Jimenez, Javier

    2008-11-01

    Direct numerical simulations are presented of isolated logarithmic layers without an underlying buffer zone. They are implemented by enforcing artificial boundary conditions within the logarithmic layer which are synthesized from values from the interior of the flow. As an example, simulations of a half-channel employing this technique are discussed. The results exhibit logarithmic mean velocity profiles, and velocity fluctuation intensities that are similar to those obtained by the full DNS of half or full channels. Those results strongly suggest that the formation of a logarithmic layer is not overly dependent on the presence of a near-wall region, and that such a flow can exist by itself. The technique enables us to perform conceptual experiments to clarify what is essential to the logarithmic layer. For example, preliminary results show that the logarithmic layer cannot be created only by a non-uniform shear, and requires a spatial gradient of the scales of the fluctuations. Somewhat surprisingly, some simulations result in Kármán constants fairly different from κ=0.4, providing clues to what determines κ in real wall turbulence.

  9. Focal myocardial infarction induces global remodeling of cardiac sympathetic innervation: neural remodeling in a spatial context

    PubMed Central

    Ajijola, Olujimi A.; Yagishita, Daigo; Patel, Krishan J.; Vaseghi, Marmar; Zhou, Wei; Yamakawa, Kentaro; So, Eileen; Lux, Robert L.; Mahajan, Aman

    2013-01-01

    Myocardial infarction (MI) induces neural and electrical remodeling at scar border zones. The impact of focal MI on global functional neural remodeling is not well understood. Sympathetic stimulation was performed in swine with anteroapical infarcts (MI; n = 9) and control swine (n = 9). A 56-electrode sock was placed over both ventricles to record electrograms at baseline and during left, right, and bilateral stellate ganglion stimulation. Activation recovery intervals (ARIs) were measured from electrograms. Global and regional ARI shortening, dispersion of repolarization, and activation propagation were assessed before and during sympathetic stimulation. At baseline, mean ARI was shorter in MI hearts than control hearts (365 ± 8 vs. 436 ± 9 ms, P < 0.0001), dispersion of repolarization was greater in MI versus control hearts (734 ± 123 vs. 362 ± 32 ms2, P = 0.02), and the infarcted region in MI hearts showed longer ARIs than noninfarcted regions (406 ± 14 vs. 365 ± 8 ms, P = 0.027). In control animals, percent ARI shortening was greater on anterior than posterior walls during right stellate ganglion stimulation (P = 0.0001), whereas left stellate ganglion stimulation showed the reverse (P = 0.0003). In infarcted animals, this pattern was completely lost. In 50% of the animals studied, sympathetic stimulation, compared with baseline, significantly altered the direction of activation propagation emanating from the intramyocardial scar during pacing. In conclusion, focal distal anterior MI alters regional and global pattern of sympathetic innervation, resulting in shorter ARIs in infarcted hearts, greater repolarization dispersion, and altered activation propagation. These conditions may underlie the mechanisms by which arrhythmias are initiated when sympathetic tone is enhanced. PMID:23893167

  10. Timing effect of intramyocardial hydrogel injection for positively impacting left ventricular remodeling after myocardial infarction.

    PubMed

    Yoshizumi, Tomo; Zhu, Yang; Jiang, Hongbin; D'Amore, Antonio; Sakaguchi, Hirokazu; Tchao, Jason; Tobita, Kimimasa; Wagner, William R

    2016-03-01

    Intramyocardial injection of various injectable hydrogel materials has shown benefit in positively impacting the course of left ventricular (LV) remodeling after myocardial infarction (MI). However, since LV remodeling is a complex, time dependent process, the most efficacious time of hydrogel injection is not clear. In this study, we injected a relatively stiff, thermoresponsive and bioabsorbable hydrogel in rat hearts at 3 different time points - immediately after MI (IM), 3d post-MI (3D), and 2 w post-MI (2W), corresponding to the beginnings of the necrotic, fibrotic and chronic remodeling phases. The employed left anterior descending coronary artery ligation model showed expected infarction responses including functional loss, inflammation and fibrosis with distinct time dependent patterns. Changes in LV geometry and contractile function were followed by longitudinal echocardiography for 10 w post-MI. While all injection times positively affected LV function and wall thickness, the 3D group gave better functional outcomes than the other injection times and also exhibited more local vascularization and less inflammatory markers than the earlier injection time. The results indicate an important role for injection timing in the increasingly explored concept of post-MI biomaterial injection therapy and suggest that for hydrogels with mechanical support as primary function, injection at the beginning of the fibrotic phase may provide improved outcomes. PMID:26774561

  11. Improvement of Prostate Treatment by Anterior Proton Fields

    SciTech Connect

    Tang, Shikui; Both, Stefan; Bentefour, Hassan; Paly, Jonathan J.; Tochner, Zelig; Efstathiou, Jason; Lu, Hsiao-Ming

    2012-05-01

    Purpose: We performed a treatment planning study to demonstrate the potential dosimetric benefits of anterior-oriented fields for prostate irradiation by proton beam. A novel in vivo beam range control method shows millimeter accuracy, suggesting that such fields could be safely used to spare the rectum given the sharp distal penumbra of protons. Methods and Materials: Ten prostate patients treated with water-filled endorectal balloon were selected. Bilateral fields were planned following the conventional treatment protocol. Three anterior-oriented fields (0, +30, -30 Degree-Sign ) were planned, with the range compensators manually adjusted to improve rectal sparing. Dose distributions to the clinical target volume, rectum, anterior rectal wall (ARW), bladder, bladder wall (BW), and femoral heads were compared for: A) equally weighted bilateral fields, B) a single straight anterior field, and C) two equally weighted anterior-oblique fields. Results: The anterior-oriented fields required much less beam energy, {approx}10 cm water equivalent path length less than lateral fields. For ARW, the V{sub 95%} for Plans A, B, and C were 39%, 8%, and 6%, respectively; the corresponding V{sub 80%} were 59%, 27%, and 26%, respectively (p = 0.002 when Plan A was compared with B or C). Plan B irradiated a larger volume of BW than did Plan A by 3% at V{sub 95%}, 11% at V{sub 80%}, and 16% at V{sub 50%} (p = 0.002), whereas Plan C differs little from Plan A for BW at these dose levels. The femoral heads received {approx}40% of the prescription dose in Plan A, but negligible dose in Plans B and C. Conclusions: Compared to lateral fields, anterior-oriented fields can significantly reduce dose to the ARW, particularly at high dose levels. These fields alone, or in combination with lateral fields, allow for the possibility of either reducing treatment toxicity at current prescription doses or further dose escalation in the treatment of prostate cancer.

  12. Assessment of myocardial perfusion in patients after the arterial switch operation

    SciTech Connect

    Vogel, M.; Smallhorn, J.F.; Gilday, D.; Benson, L.N.; Ash, J.; Williams, W.G.; Freedom, R.M. )

    1991-02-01

    In 21 patients who had undergone the arterial switch operation, the adequacy of myocardial perfusion was evaluated by thallium-201 computed scintigraphy 2.6 +/- 2 (0.3-7) yr after surgery. Fourteen patients had undergone the arterial switch procedure after pulmonary artery banding and seven as a primary repair. Isoproterenol stress increased the heart rate by at least 55%. Tomographic imaging was performed at peak stress and 3 hr later in the reperfusion phase. Nine patients had perfusion defects. The perfusion defects were located at the left ventricular apex in four (with extension to the inferolateral wall in one), left ventricular anterolateral wall in two, ventricular septum in one, left ventricular inferior wall in one, and right ventricular free wall in one. Some of these defects could be due to myocardial damage at the time of surgery, but these results also raise concern about long-term adequacy of myocardial perfusion following the arterial switch procedure.

  13. Nonsurgical reperfusion in evolving myocardial infarction

    SciTech Connect

    Ganz, W.; Geft, I.; Maddahi, J.; Berman, D.; Charuzi, Y.; Shah, P.K.; Swan, H.J.

    1983-05-01

    Nonsurgical recanalization of the occluded coronary artery has been performed in patients with evolving myocardial infarction since the late 1970s by intracoronary administration of thrombolytic agents at the ostium of the occluded artery or directly to the site of occlusion. The authors review the basic concepts underlying intracoronary thrombolysis, the method applied at their institution and the clinical results. Reperfusion of totally occluded arteries or termination of the ischemic state in subtotally occluded arteries was achieved in 71 (87.7%) of 81 patients. Reocclusion occurred in four patients, in three of these at a time when anticoagulation became temporarily ineffective, emphasizing the need for uninterrupted anticoagulation with a partial thromboplastin time longer than 80 seconds. Thallium scintigraphic studies before and after reperfusion showed a decrease in defect, indicating myocardial salvage, in the successful cases but not in failures or untreated control subjects. A decrease in thallium-201 defect was followed by improvement of regional wall motion and usually also left ventricular ejection fraction. Three of the patients with an unsuccessful result and one patient with a successful result died. Bypass surgery was performed electively in 18 patients because of multiple vessel involvement. Intracoronary thrombolysis appears to be a relatively safe and promising procedure. A large controlled study will be needed for definitive assessment of its role in the management of acute myocardial infarction.

  14. Usefulness of MRI to Differentiate Between Temporary and Long-Term Coronary Artery Occlusion in a Minimally Invasive Model of Experimental Myocardial Infarction

    SciTech Connect

    Abegunewardene, Nico Vosseler, Markus; Gori, Tommaso; Hoffmann, Nico; Schmidt, Kai-Helge; Becker, Dietmar; Kreitner, Karl-Friedrich; Petersen, Steffen E.; Schreiber, Laura M.; Horstick, Georg; Muenzel, Thomas

    2009-09-15

    The surgical technique employed to determine an experimental ischemic damage is a major factor in the subsequent process of myocardial scar development. We set out to establish a minimally invasive porcine model of myocardial infarction using cardiac contrast-enhanced magnetic resonance imaging (ce-MRI) as the basic diagnostic tool. Twenty-seven domestic pigs were randomized to either temporary or permanent occlusion of the left anterior descending artery (LAD). Temporary occlusion was achieved by inflation of a percutaneous balloon in the left anterior descending artery directly beyond the second diagonal branch. Occlusion was maintained for 30 or 45 min, followed by reperfusion. Permanent occlusion was achieved via thrombin injection. Thirteen animals died peri- or postinterventionally due to arrhythmias. Fourteen animals survived the 30-min ischemia (four animals; group 1), the 45-min ischemia (six animals; group 2), or the permanent occlusion (4 animals; group 3). Coronary angiography and ce-MRI were performed 8 weeks after coronary occlusion to document the coronary flow grade and the size of myocardial scar tissue. The LAD was patent in all animals in groups 1 and 2, with normal TIMI flow; in group 3 animals, the LAD was totally occluded. Fibrosis of the left ventricle in group 1 (4.9 {+-} 4.4%; p = 0.008) and group 2 (9.4 {+-} 2.9%; p = 0.05) was significantly lower than in group 3 (14.5 {+-} 3.9%). Wall thickness of the ischemic area was significantly lower in group 3 versus group 1 and group 2 (2.9 {+-} 0.3, 5.9 {+-} 0.7, and 6.1 {+-} 0.7 mm; p = 0.005). The extent of late enhancement of the left ventricle was also significantly higher in group 3 (16.9 {+-} 2.1%) compared to group 1 (5.3 {+-} 5.4%; p = 0.003) and group 2 (9.7 {+-} 3.4%, p = 0.013). In conclusion, the present model of minimally invasive infarction coupled with ce-MRI may represent a useful alternative to the open chest model for studies of myocardial infarction and scar development.

  15. Quantitative myocardial perfusion imaging in a porcine ischemia model using a prototype spectral detector CT system.

    PubMed

    Fahmi, Rachid; Eck, Brendan L; Levi, Jacob; Fares, Anas; Dhanantwari, Amar; Vembar, Mani; Bezerra, Hiram G; Wilson, David L

    2016-03-21

    We optimized and evaluated dynamic myocardial CT perfusion (CTP) imaging on a prototype spectral detector CT (SDCT) scanner. Simultaneous acquisition of energy sensitive projections on the SDCT system enabled projection-based material decomposition, which typically performs better than image-based decomposition required by some other system designs. In addition to virtual monoenergetic, or keV images, the SDCT provided conventional (kVp) images, allowing us to compare and contrast results. Physical phantom measurements demonstrated linearity of keV images, a requirement for quantitative perfusion. Comparisons of kVp to keV images demonstrated very significant reductions in tell-tale beam hardening (BH) artifacts in both phantom and pig images. In phantom images, consideration of iodine contrast to noise ratio and small residual BH artifacts suggested optimum processing at 70 keV. The processing pipeline for dynamic CTP measurements included 4D image registration, spatio-temporal noise filtering, and model-independent singular value decomposition deconvolution, automatically regularized using the L-curve criterion. In normal pig CTP, 70 keV perfusion estimates were homogeneous throughout the myocardium. At 120 kVp, flow was reduced by more than 20% on the BH-hypo-enhanced myocardium, a range that might falsely indicate actionable ischemia, considering the 0.8 threshold for actionable FFR. With partial occlusion of the left anterior descending (LAD) artery (FFR  <  0.8), perfusion defects at 70 keV were correctly identified in the LAD territory. At 120 kVp, BH affected the size and flow in the ischemic area; e.g. with FFR [Formula: see text] 0.65, the anterior-to-lateral flow ratio was 0.29  ±  0.01, over-estimating stenosis severity as compared to 0.42  ±  0.01 (p  <  0.05) at 70 keV. On the non-ischemic inferior wall (not a LAD territory), the flow ratio was 0.50  ±  0.04 falsely indicating an actionable ischemic condition in a healthy territory. This ratio was 1.00  ±  0.08 at 70 keV. Results suggest that projection-based keV imaging with the SDCT system and proper processing could enable useful myocardial CTP, much improved over conventional CT. PMID:26943749

  16. Quantitative myocardial perfusion imaging in a porcine ischemia model using a prototype spectral detector CT system

    NASA Astrophysics Data System (ADS)

    Fahmi, Rachid; Eck, Brendan L.; Levi, Jacob; Fares, Anas; Dhanantwari, Amar; Vembar, Mani; Bezerra, Hiram G.; Wilson, David L.

    2016-03-01

    We optimized and evaluated dynamic myocardial CT perfusion (CTP) imaging on a prototype spectral detector CT (SDCT) scanner. Simultaneous acquisition of energy sensitive projections on the SDCT system enabled projection-based material decomposition, which typically performs better than image-based decomposition required by some other system designs. In addition to virtual monoenergetic, or keV images, the SDCT provided conventional (kVp) images, allowing us to compare and contrast results. Physical phantom measurements demonstrated linearity of keV images, a requirement for quantitative perfusion. Comparisons of kVp to keV images demonstrated very significant reductions in tell-tale beam hardening (BH) artifacts in both phantom and pig images. In phantom images, consideration of iodine contrast to noise ratio and small residual BH artifacts suggested optimum processing at 70 keV. The processing pipeline for dynamic CTP measurements included 4D image registration, spatio-temporal noise filtering, and model-independent singular value decomposition deconvolution, automatically regularized using the L-curve criterion. In normal pig CTP, 70 keV perfusion estimates were homogeneous throughout the myocardium. At 120 kVp, flow was reduced by more than 20% on the BH-hypo-enhanced myocardium, a range that might falsely indicate actionable ischemia, considering the 0.8 threshold for actionable FFR. With partial occlusion of the left anterior descending (LAD) artery (FFR  <  0.8), perfusion defects at 70 keV were correctly identified in the LAD territory. At 120 kVp, BH affected the size and flow in the ischemic area; e.g. with FFR ≈ 0.65, the anterior-to-lateral flow ratio was 0.29  ±  0.01, over-estimating stenosis severity as compared to 0.42  ±  0.01 (p  <  0.05) at 70 keV. On the non-ischemic inferior wall (not a LAD territory), the flow ratio was 0.50  ±  0.04 falsely indicating an actionable ischemic condition in a healthy territory. This ratio was 1.00  ±  0.08 at 70 keV. Results suggest that projection-based keV imaging with the SDCT system and proper processing could enable useful myocardial CTP, much improved over conventional CT.

  17. Constrictive pericardial disease: prognostic significance of a nonvisualized left ventricular wall

    SciTech Connect

    Rienmueller, R.; Doppman, J.L.; Lissner, J.; Kemkes, B.M.; Strauer, B.E.

    1985-09-01

    Twenty-six patients with pericardial constriction confirmed by catheterization were studied by dynamic computed tomography (CT). The posterolateral wall of the left ventricular myocardium was not detected in five patients (19.2%). None had evidence of previous myocardial infarction on electrocardiogram or levocardiogram. In 16 patients, a pericardiectomy was performed to remove pericardial constriction. All five patients with nondetectable posterolateral walls of the left ventricle died at or immediately following surgery because of acute myocardial failure. Nonvisualization of the posterolateral wall of the left ventricle in patients with constrictive pericarditis suggests the presence of myocardial fibrosis or atrophy. Surgery is an extremely high risk in these patients.

  18. Serum thioredoxin 1 level has close relation with myocardial damage amount in acute myocardial infarction patients.

    PubMed

    Shim, Young Kwang; Kim, Jeong-Tae; Seong, Mun-Hyuk; Kim, Yeon-Jeong; Shim, Tae-Jin; Kim, Sang Min; Lee, Sang Yeub; Bae, Jang-Whan; Kim, Ki-Seok; Hwang, Kyung-Kuk; Kim, Dong-Woon; Cho, Myeong-Chan

    2012-10-01

    Thioredoxin-1 (Trx-1) is one of important anti-oxidative molecules to overcome the oxidative stress. The aim of the present study is to investigate the clinical relationship between serum concentration of Trx-1 on the pre-percutaneous coronary intervention (prePCI) and myocardial damage amount in the patients with acute myocardial infarction with the culprit lesion in only the left anterior descending artery on coronary angiography (n = 100). Initial value of creatine kinase (CK) was 368.3 ± 531.4 U/L, and MB isoenzyme of CK (CK-MB) level was 22.92 ± 33.8 ng/mL, and cardiac specific troponin T (cTnT) level was 0.61 ± 1.6 ng/mL. Positive correlations were observed between prePCI Trx-1 level and initial CK (P = 0.005, r = 0.281), and cTnT (P < 0.001, r = 0.453), peak CK (P = 0.001, r = 0.316) in all patients, but the statistical relation was observed only in ST segment elevation myocardial infarction (STEMI) patients (P = 0.008, r = 0.329 for initial CK, P = 0.001, r = 0.498 for initial cTnT, P = 0.005, r = 0.349 for peak CK), not in Non-STEMI patients. Conclusively, we consider prePCI serum Trx-1 as a predictor for myocardial damage amount in patients with STEMI. PMID:23091312

  19. Serum Thioredoxin 1 Level Has Close Relation with Myocardial Damage Amount in Acute Myocardial Infarction Patients

    PubMed Central

    Shim, Young Kwang; Kim, Jeong-Tae; Seong, Mun-Hyuk; Kim, Yeon-Jeong; Shim, Tae-Jin; Kim, Sang Min; Lee, Sang Yeub; Kim, Ki-Seok; Hwang, Kyung-Kuk; Kim, Dong-Woon; Cho, Myeong-Chan

    2012-01-01

    Thioredoxin-1 (Trx-1) is one of important anti-oxidative molecules to overcome the oxidative stress. The aim of the present study is to investigate the clinical relationship between serum concentration of Trx-1 on the pre-percutaneous coronary intervention (prePCI) and myocardial damage amount in the patients with acute myocardial infarction with the culprit lesion in only the left anterior descending artery on coronary angiography (n = 100). Initial value of creatine kinase (CK) was 368.3 ± 531.4 U/L, and MB isoenzyme of CK (CK-MB) level was 22.92 ± 33.8 ng/mL, and cardiac specific troponin T (cTnT) level was 0.61 ± 1.6 ng/mL. Positive correlations were observed between prePCI Trx-1 level and initial CK (P = 0.005, r = 0.281), and cTnT (P < 0.001, r = 0.453), peak CK (P = 0.001, r = 0.316) in all patients, but the statistical relation was observed only in ST segment elevation myocardial infarction (STEMI) patients (P = 0.008, r = 0.329 for initial CK, P = 0.001, r = 0.498 for initial cTnT, P = 0.005, r = 0.349 for peak CK), not in Non-STEMI patients. Conclusively, we consider prePCI serum Trx-1 as a predictor for myocardial damage amount in patients with STEMI. PMID:23091312

  20. Dislocation walls

    SciTech Connect

    Saada, G. ); Bouchaud, E. . Dept. of Materials Science and Metallurgy)

    1993-07-01

    The elastic properties of infinite perfect periodic planar dislocation walls are well known. It is however important to appreciate the effect of the departure from periodicity and the end effects for a finite wall. A weak uncorrelated disorder is shown to result in a long range stress field decreasing as (distance)[sup [minus]3/2] from the wall, consequences are discussed. Convenient approximate closed formulae are given and discussed for the stress field of bounded dislocation walls.

  1. Direct measurement of transmural laminar architecture in the anterolateral wall of the ovine left ventricle: new implications for wall thickening mechanics.

    PubMed

    Harrington, Katherine B; Rodriguez, Filiberto; Cheng, Allen; Langer, Frank; Ashikaga, Hiroshi; Daughters, George T; Criscione, John C; Ingels, Neil B; Miller, D Craig

    2005-03-01

    Laminar, or sheet, architecture of the left ventricle (LV) is a structural basis for normal systolic and diastolic LV dynamics, but transmural sheet orientations remain incompletely characterized. We directly measured the transmural distribution of sheet angles in the ovine anterolateral LV wall. Ten Dorsett-hybrid sheep hearts were perfusion fixed in situ with 5% buffered glutaraldehyde at end diastole and stored in 10% formalin. Transmural blocks of myocardial tissue were excised, with the edges cut parallel to local circumferential, longitudinal, and radial axes, and sliced into 1-mm-thick sections parallel to the epicardial tangent plane from epicardium to endocardium. Mean fiber directions were determined in each section from five measurements of fiber angles. Each section was then cut transverse to the fiber direction, and five sheet angles (beta) were measured and averaged. Mean fiber angles progressed nearly linearly from -41 degrees (SD 11) at the epicardium to +42 degrees (SD 16) at the endocardium. Two families of sheets were identified at approximately +45 degrees (beta(+)) and -45 degrees (beta(-)). In the lateral region (n = 5), near the epicardium, sheets belonged to the beta(+) family; in the midwall, to the beta(-) family; and near the endocardium, to the beta(+) family. This pattern was reversed in the basal anterior region (n = 4). Sheets were uniformly beta(-) over the anterior papillary muscle (n = 2). These direct measurements of sheet angles reveal, for the first time, alternating transmural families of predominant sheet angles. This may have important implications in understanding wall mechanics in the normal and the failing heart. PMID:15550521

  2. Reversibility by dipyridamole of thallium-201 myocardial scan defects in patients with sarcoidosis

    SciTech Connect

    Tellier, P.; Paycha, F.; Antony, I.; Nitenberg, A.; Valeyre, D.; Foult, J.M.; Battesti, J.P.

    1988-08-01

    In order to clarify the significance of anginal pain and myocardial thallium-201 scan defects in cardiac sarcoidosis, the pharmacologic effect of dipyridamole on myocardial perfusion was assessed by planar thallium-201 myocardial scintigraphy in patients with sarcoidosis. Thallium-201 myocardial scintigraphy was performed at rest and after 0.56 mg/kg intravenous dipyridamole during four minutes in 16 patients with sarcoidosis. The myocardial scan (45-degree and 70-degree left anterior oblique, and anterior views) was divided into 15 segments. Results were evaluated by the number of segmental defects and with a global perfusion score (from 0 to 60) by a semi-quantitative index depending on the size and severity of myocardial thallium-201 defects. Thirteen of the 16 patients showed partial or total reversion of their thallium-201 defects on redistribution scanning either at rest or after dipyridamole. The mean (+/- SD) number of myocardial perfusion defects that were present in all the patients decreased from 5.31 +/- 1.78 at rest to 3.25 +/- 2.52 after redistribution (p less than 0.001) and to 2.19 +/- 2.10 after dipyridamole (p less than 0.001). The mean global perfusion score increased from 53.2 +/- 3.0 at rest to 56.2 +/- 2.9 after redistribution (p less than 0.001) and to 57.2 +/- 2.7 after dipyridamole (p less than 0.001). A significant correlation (r = 0.82, p less than 0.001) was found between the increase of global perfusion score on redistribution and after dipyridamole. The reversibility of myocardial scan defects is a common finding in sarcoidosis. It makes unlikely the role of scar fibrosis or extensive confluent granulomas as a mechanism for such defects. The effect of dipyridamole suggests the presence of reversible disorders lying at the coronary microvascular level.

  3. Myocardial metabolism during hypoxia: Maintained lactate oxidation during increased glycolysis

    SciTech Connect

    Mazer, C.D.; Stanley, W.C.; Hickey, R.F.; Neese, R.A.; Cason, B.A.; Demas, K.A.; Wisneski, J.A.; Gertz, E.W. )

    1990-09-01

    In the intact animal, myocardial lactate utilization and oxidation during hypoxia are not well understood. Nine dogs were chronically instrumented with flow probes on the left anterior descending coronary artery and with a coronary sinus sampling catheter. ({sup 14}C)lactate and ({sup 13}C)glucose tracers, or ({sup 13}C)lactate and ({sup 14}C)glucose were administered to quantitate lactate and glucose oxidation, lactate conversion to glucose, and simultaneous lactate extraction and release. The animals were anesthetized and exposed to 90 minutes of severe hypoxia (PO2 = 25 +/- 4 torr). Hypoxia resulted in significant increases in heart rate, cardiac output and myocardial blood flow, but no significant change in myocardial oxygen consumption. The arterial/coronary sinus differences for glucose and lactate did not change from normoxia to hypoxia; however, the rate of glucose uptake increased significantly due to the increase in myocardial blood flow. Tracer-measured lactate extraction did not decrease with hypoxia, despite a 250% increase in lactate release. During hypoxia, 90% +/- 4% of the extracted {sup 14}C-lactate was accounted for by the appearance of {sup 14}CO{sub 2} in the coronary sinus, compared with 88% +/- 4% during normoxia. Thus, in addition to the expected increase in glucose uptake and lactate production, we observed an increase in lactate oxidation during hypoxia.

  4. Myocardial oxygen tensions during ischaemia in fluorocarbon diluted pigs.

    PubMed

    Faithfull, N S; Fennema, M; Erdmann, W

    1988-01-01

    Previous work by the authors has shown that, following ligation of the left anterior descending coronary artery (LAD), myocardial oxygen tension (PmO2) in expected areas of maximal ischaemia is maintained at the expense of ischaemic border zones of the infarct area. Post-ischaemic haemodilution with the fluorocarbon containing plasma substitute Fluosol-DA 20% (FDA) could significantly improve PmO2 and pre-ischaemic haemodilution can delay myocardial ischaemia. We now present an analysis of the pattern of PmO2 changes to be seen when myocardial ischaemia is induced following prior haemodilution with FDA. Two groups of juvenile Yorkshire pigs were anaesthetised with intraperitoneal thiopentone, intubated and ventilated with halothane, nitrous oxide and oxygen. After placement of cardiovascular monitoring lines, a thoracotomy was performed. The pericardium was opened and 4 steel-protected gold microelectrodes were placed in the terminal supply area of the LAD in such a way that 2 electrodes were in the area of myocardial ischaema to be produced. One group of pigs were bled (20 ml/kg) and the loss was replaced with equal volumes of FDA. The animals were ventilated with halothane and oxygen and the terminal LAD was ligated. Electrode outputs were recorded on a flat bed recorder and analysed. LAD occlusion in the control animals resulted in similar changes in PmO2 to those described above.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3364273

  5. Regional myocardial shape and dimensions of the working isolated canine left ventricle

    NASA Technical Reports Server (NTRS)

    Ritman, E. L.; Tsuiki, K.; Donald, D.; Wood, E. H.

    1975-01-01

    The extent to which the dynamic shape and dimensions of the isolated left ventricular myocardial wall differ throughout the myocardium and how these differences are characteristic of the anatomic location was demonstrated. The use of a biplane X-ray technique and a metabolically-supported isolated canine left ventricle preparation provided an angiographically ideal means of measuring mechanical dynamics of the myocardium while the intact left ventricular myocardial structure and electrical activation pattern retains most of the in situ ventricular characteristics.

  6. Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction?

    PubMed

    Harjai, Kishore J; Mehta, Rajendra H; Stone, Gregg W; Boura, Judy A; Grines, Lorelei; Brodie, Bruce R; Cox, David A; O'Neill, William W; Grines, Cindy L

    2006-08-01

    ST segment elevation myocardial infarction (STEMI) from proximally located culprit lesion is associated with greater myocardium at jeopardy. In STEMI patients treated with thrombolytics, proximal culprit lesions are known to have worse prognosis. This relation has not been studied in patients undergoing primary percutaneous coronary intervention (PCI). In 3,535 STEMI patients with native coronary artery occlusion pooled from the primary angioplasty in myocardial infarction database, we compared in-hospital and 1-year outcomes between those with proximal (n = 1,606) versus non-proximal (n = 1,929) culprit lesions. Patients with proximal culprits were more likely to die and suffer major adverse cardiovascular events (MACE) during the index hospital stay (3.8% vs 2.2%, P = 0.006; 8.2% vs 5.8%, P = 0.0066, respectively) as well as during 1-year follow-up (6.9% vs 4.5%, P = 0.0013; 22% vs 17%, P = 0.003, respectively) compared to those with non-proximal culprits. After adjustment for baseline differences, proximal culprit was independently predictive of in-hospital death (adjusted odds ratio% 1.58, 95% confidence intervals, CI 1.05-2.40) and MACE (OR 1.41, CI 1.06-1.86), but not 1-year death or MACE. In addition, proximal culprit was independently associated with higher incidence of ventricular arrhythmias and sustained hypotension during the index hospitalization. The univariate impact of proximal culprit lesion on in-hospital death and MACE was comparable to other adverse angiographic characteristics, such as multivessel disease and poor initial thrombolysis in myocardial infarction flow, and greater than that of anterior wall STEMI. In conclusion, proximal location of the culprit lesion is a strong independent predictor of worse in-hospital outcomes in patients with STEMI undergoing primary PCI. PMID:16881971

  7. Thallium myocardial perfusion scans for the assessment of right ventricular hypertrophy in patients with cystic fibrosis. A comparison with other noninvasive techniques

    SciTech Connect

    Newth, C.J.; Corey, M.L.; Fowler, R.S.; Gilday, D.L.; Gross, D.; Mitchell, I.

    1981-01-01

    The incidence of right ventricular hypertrophy in 32 patients with cystic fibrosis was studied using thallium 201 (TI-201) myocardial perfusion scans, and compared with other noninvasive techniques including electrocardiography, vectorcardiography, and M-mode echocardiography. The patients (mean age, 17.3 yr; range, 7 to 33) had a wide range of clinical and pulmonary abnormalities (mean Shwachman-Kulczycki score, 66.6). In the total study group, TI-201 scans, like the vectorcardiograms and the M-mode echocardiograms, gave a surprisingly high proportion of positive predictions for right ventricular hypertrophy (RVH) (44%). The correlations with all other noninvasive methods were uniformly poor, so caution must be exercised in using this technique to predict early RVH in order to follow the natural history of cor pulmonale in cystic fibrosis. At the time of the study, 6 patients had clinical evidence of right ventricular failure, and in this disease setting must have had RVH. In 3 patients, RVH was confirmed at autopsy, and it was successfully predicted by TI-201 scans in 5 of the 6 patients. The false negative scan may have been due to regional myocardial ischemia secondary to severe right ventricular failure. In contrast, the vectorcardiogram, using Fowler's new criteria, made a successful prediction of RVH in all 6 patients, and the electro cardiogram in only 3. Although the M-mode echocardiogram was abnormal in all patients, it would have predicted RVH (with increased right ventricular anterior wall thickness) in only 1 patient. We concluded that TI-201 myocardial perfusion cans are good at confirming RVH in cases with established right ventricular failure, but have no advantage over vectorcardiographic assessments, which are logistically easier to perform and carry no radiation risks.

  8. Anterior extrapleural line: superior extension.

    PubMed

    Whalen, J P; Oliphant, M; Evans, J A

    1975-06-01

    Anatomic sections of the superior aspect of the anterior mediastinum reveal that normal structures can cause indentations upon the adjacent lung. On lateral chest films, the soft-tissue density of the anterior superior mediastinal structures contrasts with that of the normal lung, revealing a normal, undulating configuration of the anterior superior mediastinum. We have termed this the "vascular incisura," analogous to the cardiac incisura of the left lung seen inferiorly. An appreciation of normal variations within this space is essential when evaluating pathologic alterations. PMID:1093226

  9. Quantitative Assessment of Regional Wall Motion Abnormalities Using Dual-Energy Digital Subtraction Intravenous Ventriculography

    NASA Astrophysics Data System (ADS)

    McCollough, Cynthia H.

    Healthy portions of the left ventricle (LV) can often compensate for regional dysfunction, thereby masking regional disease when global indices of LV function are employed. Thus, quantitation of regional function provides a more useful method of assessing LV function, especially in diseases that have regional effects such as coronary artery disease. This dissertation studied the ability of a phase -matched dual-energy digital subtraction angiography (DE -DSA) technique to quantitate changes in regional LV systolic volume. The potential benefits and a theoretical description of the DE imaging technique are detailed. A correlated noise reduction algorithm is also presented which raises the signal-to-noise ratio of DE images by a factor of 2 -4. Ten open-chest dogs were instrumented with transmural ultrasonic crystals to assess regional LV function in terms of systolic normalized-wall-thickening rate (NWTR) and percent-systolic-thickening (PST). A pneumatic occluder was placed on the left-anterior-descending (LAD) coronary artery to temporarily reduce myocardial blood flow, thereby changing regional LV function in the LAD bed. DE-DSA intravenous left ventriculograms were obtained at control and four levels of graded myocardial ischemia, as determined by reductions in PST. Phase-matched images displaying changes in systolic contractile function were created by subtracting an end-systolic (ES) control image from ES images acquired at each level of myocardial ischemia. The resulting wall-motion difference signal (WMD), which represents a change in regional systolic volume between the control and ischemic states, was quantitated by videodensitometry and compared with changes in NWTR and PST. Regression analysis of 56 data points from 10 animals shows a linear relationship between WMD and both NWTR and PST: WMD = -2.46 NWTR + 13.9, r = 0.64, p < 0.001; WMD = -2.11 PST + 18.4, r = 0.54, p < 0.001. Thus, changes in regional ES LV volume between rest and ischemic states, as measured using the described imaging technique, appear linearly related to changes in wall-thickening, as measured using transmural ultrasonic crystals. This type of image analysis may prove useful in a variety of clinical and research applications and further investigation is proposed.

  10. Quantitative Texture Analysis and Transesophageal Echocardiography to Characterize the Acute Myocardial Contusion

    PubMed Central

    Amichi, Abdelaziz; Laugier, Pascal

    2009-01-01

    Myocardial contusion (MC) is a common injury following blunt chest trauma without any specific symptoms. Several techniques such as electrocardiogram, estimation of myocardial band fraction of creatine phosphokinase, chest radiography and the scintiscanning missed efficiency to characterize the MC. Another technique based on transesophageal echocardiography [TEE] allows to visualize the structures of the heart with a good spatial resolution. We postulated that the quantitative texture analysis of regional image texture in two- dimensional [2D] TEE echocardiograms would be an accurate method to differentiate normal from abnormal myocardial wall. This preliminary experimental study demonstrated the feasibility of the proposed technique. PMID:19587806

  11. Early myocardial damage assessment in dystrophinopathies using 99Tcm-MIBI gated myocardial perfusion imaging

    PubMed Central

    Zhang, Li; Liu, Zhe; Hu, Ke-You; Tian, Qing-Bao; Wei, Ling-Ge; Zhao, Zhe; Shen, Hong-Rui; Hu, Jing

    2015-01-01

    Background Early detection of muscular dystrophy (MD)-associated cardiomyopathy is important because early medical treatment may slow cardiac remodeling and attenuate symptoms of cardiac dysfunction; however, no sensitive and standard diagnostic method for MD at an earlier stage has been well-recognized. Thus, the aim of this study was to test the early diagnostic value of technetium 99m-methoxyisobutylisonitrile (99Tcm-MIBI) gated myocardial perfusion imaging (G-MPI) for MD. Methods and results Ninety-one patients underwent 99Tcm-MIBI G-MPI examinations when they were diagnosed with Duchenne muscular dystrophy (DMD) (n=77) or Becker muscular dystrophy (BMD; n=14). 99Tcm-MIBI G-MPI examinations were repeated in 43 DMD patients who received steroid treatments for 2 years as a follow-up examination. Myocardial defects were observed in nearly every segment of the left ventricular wall in both DMD and BMD patients compared with controls, especially in the inferior walls and the apices by using 99Tcm-MIBI G-MPI. Cardiac wall movement impairment significantly correlated with age in the DMD and BMD groups (rs=0.534 [P<0.05] and rs=0.784 [P<0.05], respectively). Intermittent intravenous doses of glucocorticoids and continuation with oral steroid treatments significantly improved myocardial function in DMD patients (P<0.05), but not in BMD patients. Conclusion 99Tcm-MIBI G-MPI is a sensitive and safe approach for early evaluation of cardiomyopathy in patients with DMD or BMD, and can serve as a candidate method for the evaluation of progression, prognosis, and assessment of the effect of glucocorticoid treatment in these patients. PMID:26677332

  12. Spontaneous coronary artery dissection as a cause of myocardial infarction.

    PubMed

    Aksakal, Aytekin; Arslan, Uğur; Yaman, Mehmet; Urumdaş, Mehmet; Ateş, Ahmet Hakan

    2014-12-26

    Spontaneous coronary artery dissection (SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending (LAD) artery and left circumflex (LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case. PMID:25548620

  13. [Acute myocardial infarction triggered by salbutamol in asthma bronchiale].

    PubMed

    Tomcsányi, János; Somlói, Miklós; Frész, Tamás; Arabadzisz, Hrisula; Zsoldos, András; Vecsey, Tibor

    2006-11-26

    The authors report the case of an 77-year-old woman with no evidence of previous cardiac disease who developed a non-Q-wave myocardial infarction after beta2-mimetic treatment for the exacerbation of her chronic bronchial asthma. After the five dose of salbutamol spray she developed chest pain. The electrogram showed ST segment elevation in leads I-aVL-V4-6. Urgent coronary angiography showed only non significant left anterior coronary artery stenosis (20%). A subsequent echocardiogram also revealed anterolateral hypokinesia and acute reversible left ventricular dysfunction (LVEF:30%). Both troponin T concentration and creatine kinase rose. Next day in the lateral leads negative T-waves developed with QT-prolongation and without pathologic Q-waves. Although myocardial infarction and acute reversible left ventricular dysfunction is a rare complication following beta2 mimetic treatment one should use high-dose beta2-agonists with caution. PMID:17380691

  14. [Bonsai induced acute myocardial infarction].

    PubMed

    Ayhan, Hüseyin; Aslan, Abdullah Nabi; Süygün, Hakan; Durmaz, Tahir

    2014-09-01

    Incidences of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. There is no any literature about a synthetic cannabinoid, being recently most popular Bonsai, to cause myocardial infarction. In this case report we presented a 33-year-old male patient who developed acute myocardial infarction after taking high doses of Bonsai. PMID:25362948

  15. Myocardial infarction after rituximab infusion.

    PubMed

    Renard, Dimitri; Cornillet, Luc; Castelnovo, Giovanni

    2013-07-01

    Myocardial infarction after rituximab or other monoclonal antibody therapies has been reported in rare cases, all in patients with classical cardiovascular risk factors or associated inflammatory or lymphoproliferative disorders. We report the case of a 52-year-old man, without classical cardiovascular risk factors or associated inflammatory or lymphoproliferative disorder, treated for seronegative myasthenia with rituximab infusions complicated by myocardial infarction. The exact origin of myocardial infarction after monoclonal antibody treatment is unclear. Myocardial infarction is a rare but possibly fatal complication of rituximab infusion, even occurring in relatively young patients, without classical risk factors and without associated inflammatory or lymphoproliferative disorder. PMID:23768984

  16. Severe coronary tortuosity or myocardial bridging in patients with chest pain, normal coronary arteries, and reversible myocardial perfusion defects.

    PubMed

    Gaibazzi, Nicola; Rigo, Fausto; Reverberi, Claudio

    2011-10-01

    We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p <0.001) or myocardial bridging (13% vs 2%, p <0.05) was 7 times higher in patients who demonstrated reversible perfusion defects at cSE compared to those without reversible perfusion defects. No significant differences were found between the 2 groups for the main demographic variables and risk factors. Patients in the false-positive group more frequently had a history of effort angina (p <0.001) and ST-segment depression at treadmill electrocardiography (p <0.001). In conclusion, we hypothesize that patients with a positive myocardial perfusion finding at cSE but without obstructive epicardial coronary artery disease have a decreased myocardial blood flow reserve, which may be caused by a spectrum of causes other than obstructive coronary artery disease, among which severely tortuous coronary arteries/myocardial bridging may play a significant role. PMID:21784382

  17. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  18. Anterior Cruciate Ligament Injury

    PubMed Central

    Vilaseca, Tomas; Chahla, Jorge; Rodriguez, Gustavo Gomez; Arroquy, Damián; Herrera, Gonzalo Perez; Orlowski, Belen; Carboni, Martín

    2015-01-01

    Objectives: The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterior cruciate ligament (ACL) than in a control group of volunteers without knee pathology. Methods: We included prospectively recreational athletes between 18 and 40 years with an acute ACL injury between January 2011 and January 2013. They were compared with a control group of volunteers recreational athletes without lower limb pathology and in the same range of age. The internal and external rotations passively prior to the point at which the pelvis movement contributes were observed. The results were statistically analyzed using t test for related samples to the hips of patients with ACL injury and t test for independent variables for comparison with the control group. Results: 48 patients with ACL injury and 53 healthy volunteers were evaluated. The ACL group was composed of 32 males and 16 females with an average age of 29.3 years. In the control group 26 males and 27 females were studied with a mean age of 26.6 years. Internal (IR) and external (ER) rotation in the LCA group was 22,9º and 55,5º respectively in the ipsilateral hip and 27,9º and 57,7º in the contralateral. In the control group a 35,9º of IR and 55,2º of ER was observed. The analysis showed an association between ACL injury and hypomotility of the hip further expense of a decrease in internal rotation. The analysis showed an association between ACL injury and hypomotility of the hip at the expense to a greater decrease in internal rotation. Conclusion: We found a statistically significant difference in the mobility of the hips in patients with ACL injury predominantly due to internal rotation, pattern that allows us to interpret this injury not only as an intrinsic etiology of the knee but also of the adjacent joints. We consider very importance to incorporate prevention activities and screening of risk factors regarding to at least high performance athletes.

  19. Quantitative analysis of regional myocardial performance in coronary artery disease

    NASA Technical Reports Server (NTRS)

    Stewart, D. K.; Dodge, H. T.; Frimer, M.

    1975-01-01

    Findings from a group of subjects with significant coronary artery stenosis are given. A group of controls determined by use of a quantitative method for the study of regional myocardial performance based on the frame-by-frame analysis of biplane left ventricular angiograms are presented. Particular emphasis was placed upon the analysis of wall motion in terms of normalized segment dimensions, timing and velocity of contraction. The results were compared with the method of subjective assessment used clinically.

  20. Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery

    PubMed Central

    Pretto, Pericles; Martins, Gerez Fernandes; Biscaro, Andressa; Kruczan, Dany David; Jessen, Barbara

    2015-01-01

    Introduction Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. Objective To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. Methods Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. Results We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. Conclusion The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death. PMID:25859867

  1. Transthoracic coronary flow reserve and dobutamine derived myocardial function: a 6-month evaluation after successful coronary angioplasty

    PubMed Central

    Cicala, Silvana; Galderisi, Maurizio; Guarini, Pasquale; D'Errico, Arcangelo; Innelli, Pasquale; Pardo, Moira; Scognamiglio, Giancarlo; de Divitiis, Oreste

    2004-01-01

    After percutaneous transluminal coronary angioplasty (PTCA), stress-echocardiography and gated single photon emission computerized tomography (g-SPECT) are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD) six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR) and color Tissue Doppler (C-TD) dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio) and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm) and diastolic (Em and Am, Em/Am ratio) peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI) and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 0.4 versus 2.87 0.6, p < 0.002) and septal Sm at high-dose dobutamine (p < 0.01), with higher WMSI (p < 0.05) and stress-echo positivity of LAD territory in 5/11 patients. In the overall population, CFR was related negatively to high-dobutamine WMSI (r = -0.50, p < 0.01) and positively to high-dobutamine Sm of middle septum (r = 0.55, p < 0.005). In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD. PMID:15581428

  2. The Early-Onset Myocardial Infarction Associated PHACTR1 Gene Regulates Skeletal and Cardiac Alpha-Actin Gene Expression

    PubMed Central

    Kelloniemi, Annina; Szabo, Zoltan; Serpi, Raisa; Näpänkangas, Juha; Ohukainen, Pauli; Tenhunen, Olli; Kaikkonen, Leena; Koivisto, Elina; Bagyura, Zsolt; Kerkelä, Risto; Leosdottir, Margret; Hedner, Thomas; Melander, Olle

    2015-01-01

    The phosphatase and actin regulator 1 (PHACTR1) locus is a very commonly identified hit in genome-wide association studies investigating coronary artery disease and myocardial infarction (MI). However, the function of PHACTR1 in the heart is still unknown. We characterized the mechanisms regulating Phactr1 expression in the heart, used adenoviral gene delivery to investigate the effects of Phactr1 on cardiac function, and analyzed the relationship between MI associated PHACTR1 allele and cardiac function in human subjects. Phactr1 mRNA and protein levels were markedly reduced (60%, P<0.01 and 90%, P<0.001, respectively) at 1 day after MI in rats. When the direct myocardial effects of Phactr1 were studied, the skeletal α-actin to cardiac α-actin isoform ratio was significantly higher (1.5-fold, P<0.05) at 3 days but 40% lower (P<0.05) at 2 weeks after adenovirus-mediated Phactr1 gene delivery into the anterior wall of the left ventricle. Similarly, the skeletal α-actin to cardiac α-actin ratio was lower at 2 weeks in infarcted hearts overexpressing Phactr1. In cultured neonatal cardiac myocytes, adenovirus-mediated Phactr1 overexpression for 48 hours markedly increased the skeletal α-actin to cardiac α-actin ratio, this being associated with an enhanced DNA binding activity of serum response factor. Phactr1 overexpression exerted no major effects on the expression of other cardiac genes or LV structure and function in normal and infarcted hearts during 2 weeks’ follow-up period. In human subjects, MI associated PHACTR1 allele was not associated significantly with cardiac function (n = 1550). Phactr1 seems to regulate the skeletal to cardiac α-actin isoform ratio. PMID:26098115

  3. Diagnostic ultrasound induced inertial cavitation to non-invasively restore coronary and microvascular flow in acute myocardial infarction.

    PubMed

    Xie, Feng; Gao, Shunji; Wu, Juefei; Lof, John; Radio, Stanley; Vignon, Francois; Shi, William; Powers, Jeffry; Unger, Evan; Everbach, E Carr; Liu, Jinjin; Porter, Thomas R

    2013-01-01

    Ultrasound induced cavitation has been explored as a method of dissolving intravascular and microvascular thrombi in acute myocardial infarction. The purpose of this study was to determine the type of cavitation required for success, and whether longer pulse duration therapeutic impulses (sustaining the duration of cavitation) could restore both microvascular and epicardial flow with this technique. Accordingly, in 36 hyperlipidemic atherosclerotic pigs, thrombotic occlusions were induced in the mid-left anterior descending artery. Pigs were then randomized to either a) dose tissue plasminogen activator (0.5 mg/kg) alone; or same dose plasminogen activator and an intravenous microbubble infusion with either b) guided high mechanical index short pulse (2.0 MI; 5 usec) therapeutic ultrasound impulses; or c) guided 1.0 mechanical index long pulse (20 usec) impulses. Passive cavitation detectors indicated the high mechanical index impulses (both long and short pulse duration) induced inertial cavitation within the microvasculature. Epicardial recanalization rates following randomized treatments were highest in pigs treated with the long pulse duration therapeutic impulses (83% versus 59% for short pulse, and 49% for tissue plasminogen activator alone; p<0.05). Even without epicardial recanalization, however, early microvascular recovery occurred with both short and long pulse therapeutic impulses (p<0.005 compared to tissue plasminogen activator alone), and wall thickening improved within the risk area only in pigs treated with ultrasound and microbubbles. We conclude that although short pulse duration guided therapeutic impulses from a diagnostic transducer transiently improve microvascular flow, long pulse duration therapeutic impulses produce sustained epicardial and microvascular re-flow in acute myocardial infarction. PMID:23922797

  4. The effects of hypoxemia on myocardial blood flow during exercise.

    PubMed

    Paridon, S M; Bricker, J T; Dreyer, W J; Reardon, M; Smith, E O; Porter, C B; Michael, L; Fisher, D J

    1989-03-01

    We evaluated the adequacy of regional and transmural blood flow during exercise and rapid pacing after 1 wk of hypoxemia. Seven mature mongrel dogs were made hypoxemic (mean O2 saturation = 72.4%) by anastomosis of left pulmonary artery to left atrial appendage. Catheters were placed in the left atrium, right atrium, pulmonary artery, and aorta. Atrial and ventricular pacing wires were placed. An aortic flow probe was placed to measure cardiac output. Ten nonshunted dogs, similarly instrumented, served as controls. Recovery time was approximately 1 wk. Cardiac output, mean aortic pressure, and oxygen saturation were measured at rest, with ventricular pacing, atrial pacing, and with treadmill exercise. Ventricular and atrial pace and exercise were at a heart rate of 200. Right ventricular free wall, left ventricular free wall, and septal blood flow were measured with radionuclide-labeled microspheres. Cardiac output, left atrial blood pressure, and aortic blood pressure were similar between the two groups of dogs in all testing states. Myocardial blood flow was significantly higher in the right and left ventricular free wall in the hypoxemic animals during resting and exercise testing states. Myocardial oxygen delivery was similar between the two groups of animals. Pacing resulted in an increase in myocardial blood flow in the control animals but not the hypoxemic animals.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2704596

  5. Prednisone induced two-way myocardial development in a patient with systemic lupus erythematosus

    PubMed Central

    Jiang, Meng; Pu, Jun; Shen, Xue-dong; He, Ben

    2014-01-01

    We present a series of echocardiography images to demonstrate the myocardial response to a high dose of prednisone. A young woman with systemic lupus erythematosus (SLE) associated with interventricular septal hypertrophy exhibited a high pressure gradient between the ascending aorta and left ventricular outflow tract as well as significant systolic anterior motion (SAM) and mitral regurgitation (MR) during high-dose prednisone treatment. However, the pressure gradient decreased dramatically and the MR disappeared rapidly when the dose of prednisone was reduced. To the best of our knowledge, this is the only adult case of myocardial hypertrophy that is assumed to be related to prednisone use. PMID:24789158

  6. A Tissue-Engineered Chondrocyte Cell Sheet Induces Extracellular Matrix Modification to Enhance Ventricular Biomechanics and Attenuate Myocardial Stiffness in Ischemic Cardiomyopathy.

    PubMed

    Shudo, Yasuhiro; Cohen, Jeffrey E; MacArthur, John W; Goldstone, Andrew B; Otsuru, Satoru; Trubelja, Alen; Patel, Jay; Edwards, Bryan B; Hung, George; Fairman, Alexander S; Brusalis, Christopher; Hiesinger, William; Atluri, Pavan; Hiraoka, Arudo; Miyagawa, Shigeru; Sawa, Yoshiki; Woo, Y Joseph

    2015-10-01

    There exists a substantial body of work describing cardiac support devices to mechanically support the left ventricle (LV); however, these devices lack biological effects. To remedy this, we implemented a cell sheet engineering approach utilizing chondrocytes, which in their natural environment produce a relatively elastic extracellular matrix (ECM) for a cushioning effect. Therefore, we hypothesized that a chondrocyte cell sheet applied to infarcted and borderzone myocardium will biologically enhance the ventricular ECM and increase elasticity to augment cardiac function in a model of ischemic cardiomyopathy (ICM). Primary articular cartilage chondrocytes of Wistar rats were isolated and cultured on temperature-responsive culture dishes to generate cell sheets. A rodent ICM model was created by ligating the left anterior descending coronary artery. Rats were divided into two groups: cell sheet transplantation (1.0??10(7) cells/dish) and no treatment. The cell sheet was placed onto the surface of the heart covering the infarct and borderzone areas. At 4 weeks following treatment, the decreased fibrotic extension and increased elastic microfiber networks in the infarct and borderzone areas correlated with this technology's potential to stimulate ECM formation. The enhanced ventricular elasticity was further confirmed by the axial stretch test, which revealed that the cell sheet tended to attenuate tensile modulus, a parameter of stiffness. This translated to increased wall thickness in the infarct area, decreased LV volume, wall stress, mass, and improvement of LV function. Thus, the chondrocyte cell sheet strengthens the ventricular biomechanical properties by inducing the formation of elastic microfiber networks in ICM, resulting in attenuated myocardial stiffness and improved myocardial function. PMID:26154752

  7. Mediastinal mature teratoma with complete gastrointestinal and bronchial walls

    PubMed Central

    Takanashi, Yusuke; Tajima, Shogo; Takahashi, Tsuyoshi; Shinmura, Kazuya; Koyama, Shin; Neyatani, Hiroshi

    2015-01-01

    An extremely rare case of anterior mediastinal mature teratoma with almost complete gastrointestinal and bronchial walls is described. A 65-year-old woman presented with left precordial pain. Chest computed tomography showed a huge anterior mediastinal tumor, 15 cm × 21 cm, occupying the left thoracic cavity. Post-resection histopathological examination confirmed the diagnosis of mature teratoma and demonstrated almost complete gastrointestinal and bronchial walls. Although mature teratomas of the ovary and sacrococcygeal area are known to rarely contain organoid structures with various degrees of differentiation, this is the first case of an anterior mediastinal mature teratoma that contained well-developed organoid structures. PMID:26392853

  8. Diurnal variations in myocardial metabolism

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The heart is challenged by a plethora of extracellular stimuli over the course of a normal day, each of which distinctly influences myocardial contractile function. It is therefore not surprising that myocardial metabolism also oscillates in a time-of-day dependent manner. What is becoming increasin...

  9. Dipyridamole thallium-201 myocardial scintigraphy

    SciTech Connect

    Not Available

    1988-09-01

    Thallium-201 (/sup 201/Tl) myocardial scintigraphy is a sensitive technique for detecting coronary artery disease. Standardized exercise testing is the most common method for inducing myocardial stress for /sup 201/Tl imaging. Unfortunately, a significant number of patients are unable to undergo adequate treadmill or bicycle exercise. In these patients, pharmacologic stress with dipyridamole provides a safe, efficacious, and reliable alternative.

  10. Efficacy of long-term anticoagulant treatment in subgroups of patients after myocardial infarction.

    PubMed Central

    van Bergen, P. F.; Deckers, J. W.; Jonker, J. J.; van Domburg, R. T.; Azar, A. J.; Hofman, A.

    1995-01-01

    OBJECTIVE--To investigate the efficacy of long term oral anticoagulant treatment in subgroups of patients after myocardial infarction. DESIGN--Analysis of the effect of anticoagulant treatment in subgroups of hospital survivors of myocardial infarction based upon age, gender, history of hypertension, previous myocardial infarction, smoking habits, diabetes mellitus, Killip class, anterior location of infarction, thrombolytic therapy, and use of beta blockers. SUBJECTS--Participants of a multicentre, randomised, double blind, placebo controlled trial that assessed the effect of oral anticoagulant treatment on mortality as well as cerebrovascular and cardiovascular morbidity in 3404 hospital survivors of acute myocardial infarction. MAIN OUTCOME MEASURES--The effect of anticoagulant treatment on recurrent myocardial infarction, cerebrovascular events, and vascular events (the composite endpoint of reinfarction, cerebrovascular event, and vascular death). RESULTS--Long term anticoagulant treatment was associated with a reduction in mortality of 10% (95% confidence interval -11% to 27%), recurrent myocardial infarction of 53% (41% to 62%), cerebrovascular events of 40% (10% to 60%) and vascular events of 35% (24% to 45%). Treatment effect with respect to recurrent myocardial infarction was comparable among all subgroups of patients. Although treatment effect appeared to be somewhat smaller in females than in males (-11% v -45%), and in patients with diabetes compared to those without (-14% v -42%) with respect to vascular events, none of these differences reached statistical significance. In multivariate analysis, more advanced age, previous myocardial infarction, diabetes mellitus, and heart failure during admission were independently associated with increased incidence of cardiovascular complications. CONCLUSIONS--The relative benefit of long term anticoagulant therapy in survivors of myocardial infarction is not modified by known prognostic factors for cardiovascular disease. PMID:7546987

  11. Transient mitral regurgitation: An adjunctive sign of myocardial ischemia during dipyridamole-thallium imaging

    SciTech Connect

    Lette, J.; Gagnon, A.; Lapointe, J.; Cerino, M.

    1989-07-01

    A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm.

  12. Spiral MR myocardial tagging.

    PubMed

    Ryf, Salome; Kissinger, Kraig V; Spiegel, Marcus A; Börnert, Peter; Manning, Warren J; Boesiger, Peter; Stuber, Matthias

    2004-02-01

    In the present study, complementary spatial modulation of magnetization (CSPAMM) myocardial tagging was extended with an interleaved spiral imaging sequence. The use of a spiral sequence enables the acquisition of grid-tagged images with a tagline distance as low as 4 mm in a single breath-hold. Alternatively, a high temporal resolution of 77 frames per second was obtained with 8-mm grid spacing. Ten healthy adult subjects were studied. With this new approach, high-quality images can be obtained and the tags persist throughout the entire cardiac cycle. PMID:14755646

  13. Myocardial protection by ischemic preconditioning: the influence of the composition of myocardial phospholipids.

    PubMed

    al Makdessi, S; Brändle, M; Ehrt, M; Sweidan, H; Jacob, R

    1995-04-12

    It was the aim of this study to investigate (1) whether preconditioning modifies the fatty acid (FA) composition of myocardial phospholipids (PL), (2) whether a previous modification of membrane PL composition by the administration of coconut oil or fish oil influences the preconditioning, and (3) to compare the protective effects of preconditioning to those of dietary fish oil. To this end, three groups of rats were given during 10 weeks either a standard diet, or a standard diet + 10% coconut oil, or a standard diet + 10% fish oil. The preconditioning was performed in situ in the anesthetized open-chest rats by 2 cycles of 3 min left anterior descending coronary artery occlusion and 10 min reperfusion. It was followed by a 40 min ischemia and a 60 min reperfusion. ECG was recorded and used for the continuous count of the salves of extrasystoles, ventricular flutter and fibrillation. These rhythm disturbances were subsequently added and evaluated as total arrhythmias. The FA of tissue PL were analyzed in a sample of the ischemic zone the size of which was determined by means of malachite green. Coconut oil diet (rich in saturated FA) modified slightly the myocardial PL by increasing oleic acid and decreasing linoleic acid and resulted in the highest incidence of arrhythmias. Fish oil diet had the opposite effect in modifying drastically the PLFA (replacement of the n-6 FA by the n-3 FA) and minimizing significantly the arrhythmias in comparison with the standard diet group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7659079

  14. Significance of 99mTc-Sestamibi myocardial scintigraphy after percutaneous coronary intervention in patients with acute myocardial infarction

    PubMed Central

    Akashi, Yoshihiro J.; Ashikaga, Kohei; Takano, Makoto; Izumo, Masaki; Ishibashi, Yuki; Kida, Keisuke; Yoneyama, Kihei; Suzuki, Kengo; Miyake, Fumihiko; Banach, Maciej

    2011-01-01

    Summary Background This study was designed to clarify the significance of washout rate (WR) determined from 99mTc-sestamibi myocardial scintigraphic images and the levels of cardiac enzymes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Material/Methods A total of 56 consecutive patients with AMI (mean age 65.8±8.5 years), who underwent PCI on admission, were included. Cardiac enzyme, the MB isoenzyme of creatinine kinase (CK-MB), was measured every 3 h after admission. Two weeks after the onset of AMI, 99mTc-sestamibi myocardial scintigraphy was performed at early (30 min) and delayed (4 h) phases after tracer injection. The heart-to-mediastinum ratio (H/M) and WR were calculated from the planar images. Results PCI was performed at 9.4±6.0 h after the onset of AMI. In 26 patients the culprit lesion was located in the right coronary artery and in 24 patients it was located in the left anterior descending coronary artery. The peak CK-MB was 274.1±169.4 IU/L (13.5±3.9 h). The early and delayed H/Ms and WR of 99mTc-sestamibi were 2.74±0.58, 3.00±0.70, and 58.8±10.0%, respectively. The delayed H/M was significantly correlated with the peak CK-MB (r=−0.37, p=0.005). The WR of 99mTc-sestamibi was also significantly correlated with the peak CK-MB (r=−0.34, p=0.012). Conclusions These results suggest that the WR determined from 99mTc-sestamibi myocardial scintigraphic images reflects the extent of myocardial damage in AMI patients. PMID:21358600

  15. Travoprost Induced Granulomatous Anterior Uveitis

    PubMed Central

    Chiam, Patrick

    2011-01-01

    Purpose. To report a case of granulomatous anterior uveitis caused by travoprost. Methods. Single observational case report. Results. A 71-year-old who was fit and healthy presented with bilateral granulomatous anterior uveitis 2 months after he was started on travoprost in both eyes. There was no past history of uveitis. Blood test and radiological investigation were unremarkable. Travoprost was stopped. The uveitis resolved on topical steroid treatment. A rechallenge with travoprost was attempted in one eye. The inflammation recurred in this eye only. This subsided with the cessation of travoprost alone without topical steroid. Conclusion. This is the first case report of travoprost causing granulomatous anterior uveitis. The uveitis recurred with a rechallenge. Changing the prostaglandin analogue to another topical treatment may be adequate to cease the inflammation. PMID:22606464

  16. Sequential radionuclide angiographic assessment of left and right ventricular performance and quantitative thallium-201 scintigraphy following acute myocardial infarction

    SciTech Connect

    Hirsowitz, G.S.; Lakier, J.B.; Marks, D.S.; Lee, T.G.; Goldberg, A.D.; Goldstein, S.

    1984-05-01

    Sequential changes in radionuclide angiographic measurement of left and right ventricular performance and quantitative thallium-201 scintigraphy were studied in 20 patients sustaining their first acute myocardial infarction (AMI). The studies were performed on the average 29.4 hours and 9.4 days after hospital admission. Anterior infarction had greater impairment of left ventricular (LV) performance in terms of ejection fraction and percentage of abnormal contraction area in addition to larger thallium-201 perfusion defects. At the time of the late study evidence of thallium-201 perfusion of infarcted area was seen in 14 of 20 patients, five of whom demonstrated improvement of regional wall motion. The remaining patients in the reperfused group and all of the patients in the nonperfused group failed to show evidence of LV functional improvement. This study indicates that reperfusion as measured by thallium-201 scintigraphy does occur spontaneously in 70% of patients with AMI and only in those patients with established reperfusion is there any potential for improvement in LV performance.

  17. Assessment of single vessel coronary artery disease: results of exercise electrocardiography, thallium-201 myocardial perfusion imaging and radionuclide angiography

    SciTech Connect

    Port, S.C.; Oshima, M.; Ray, G.; McNamee, P.; Schmidt, D.H.

    1985-07-01

    The sensitivity of the commonly used stress tests for the diagnosis of coronary artery disease was analyzed in 46 patients with significant occlusion (greater than or equal to 70% luminal diameter obstruction) of only one major coronary artery and no prior myocardial infarction. In all patients, thallium-201 perfusion imaging (both planar and seven-pinhole tomographic) and 12 lead electrocardiography were performed during the same graded treadmill exercise test and radionuclide angiography was performed during upright bicycle exercise. Exercise rate-pressure (double) product was 22,307 +/- 6,750 on the treadmill compared with 22,995 +/- 5,622 on the bicycle (p = NS). Exercise electrocardiograms were unequivocally abnormal in 24 patients (52%). Qualitative planar thallium images were abnormal in 42 patients (91%). Quantitative analysis of the tomographic thallium images were abnormal in 41 patients (89%). An exercise ejection fraction of less than 0.56 or a new wall motion abnormality was seen in 30 patients (65%). Results were similar for the right (n = 11) and left anterior descending (n = 28) coronary arteries while all tests but the planar thallium imaging showed a lower sensitivity for isolated circumflex artery disease (n = 7). The specificity of the tests was 72, 83, 89 and 72% for electrocardiography, planar thallium imaging, tomographic thallium imaging and radionuclide angiography, respectively. The results suggest that exercise thallium-201 perfusion imaging is the most sensitive noninvasive stress test for the diagnosis of single vessel coronary artery disease.

  18. Endoderm convergence controls subduction of the myocardial precursors during heart-tube formation.

    PubMed

    Ye, Ding; Xie, Huaping; Hu, Bo; Lin, Fang

    2015-09-01

    Coordination between the endoderm and adjacent cardiac mesoderm is crucial for heart development. We previously showed that myocardial migration is promoted by convergent movement of the endoderm, which itself is controlled by the S1pr2/Gα13 signaling pathway, but it remains unclear how the movements of the two tissues is coordinated. Here, we image live and fixed embryos to follow these movements, revealing previously unappreciated details of strikingly complex and dynamic associations between the endoderm and myocardial precursors. We found that during segmentation the endoderm underwent three distinct phases of movement relative to the midline: rapid convergence, little convergence and slight expansion. During these periods, the myocardial cells exhibited different stage-dependent migratory modes: co-migration with the endoderm, movement from the dorsal to the ventral side of the endoderm (subduction) and migration independent of endoderm convergence. We also found that defects in S1pr2/Gα13-mediated endodermal convergence affected all three modes of myocardial cell migration, probably due to the disruption of fibronectin assembly around the myocardial cells and consequent disorganization of the myocardial epithelium. Moreover, we found that additional cell types within the anterior lateral plate mesoderm (ALPM) also underwent subduction, and that this movement likewise depended on endoderm convergence. Our study delineates for the first time the details of the intricate interplay between the endoderm and ALPM during embryogenesis, highlighting why endoderm movement is essential for heart development, and thus potential underpinnings of congenital heart disease. PMID:26329600

  19. A Nonthoracotomy Myocardial Infarction Model in an Ovine Using Autologous Platelets

    PubMed Central

    Spata, Tyler; Bobek, Daniel; Whitson, Bryan A.; Parthasarathy, Sampath; Mohler, Peter J.; Higgins, Robert S. D.; Kilic, Ahmet

    2013-01-01

    Objective. There is a paucity of a biological large animal model of myocardial infarction (MI). We hypothesized that, using autologous-aggregated platelets, we could create an ovine model that was reproducible and more closely mimicked the pathophysiology of MI. Methods. Mepacrine stained autologous platelets from male sheep (n = 7) were used to create a myocardial infarction via catheter injection into the mid-left anterior descending (LAD) coronary artery. Serial daily serum troponin measurements were taken and tissue harvested on post-embolization day three. Immunofluorescence microscopy was used to detect the mepacrine-stained platelet-induced thrombus, and histology performed to identify three distinct myocardial (infarct, peri-ischemic “border zone,” and remote) zones. Results. Serial serum troponin levels (μg/mL) measured 0.0 ± 0.0 at baseline and peaked at 297.4 ± 58.0 on post-embolization day 1, followed by 153.0 ± 38.8 on day 2 and 76.7 ± 19.8 on day 3. Staining confirmed distinct myocardial regions of inflammation and fibrosis as well as mepacrine-stained platelets as the cause of intravascular thrombosis. Conclusion. We report a reproducible, unique model of a biological myocardial infarction in a large animal model. This technique can be used to study acute, regional myocardial changes following a thrombotic injury. PMID:24367790

  20. Ventricular myocardial architecture in marine fishes.

    PubMed

    Sanchez-Quintana, D; Hurle, J M

    1987-03-01

    The fiber architecture of the ventricular myocardium has been studied in elasmobranch (Isurus oxyrhinchus, Galeorhinus galeus, Prionace glauca) and teleost (Xiphias gladius, Thunnus thynnus, Thunnus alalunga) fish species with hearts displaying mixed types of ventricular musculature (compact and trabecular). In all cases, the compact myocardium is organized in layers of fiber bundles with an orderly arrangement within the ventricular walls. The number of these layers appears to be dependent on the relative thickness of the compact myocardium. Differences in the pattern of myocardial fiber arrangement were observed among the different fish species. In elasmobranchs the compact myocardium at the level of the atrioventricular orifice is continuous with the trabeculated myocardium. Furthermore, in elasmobranchs the trabeculated myocardium displays a precise arrangement in arcuate trabeculae running from the auriculoventricular to the conoventricular orifices. In teleosts, the compact myocardium is independent of the trabeculated myocardium and a large number of fibers insert into the bulboventricular fibrous ring. The trabeculated myocardium in these species displays an anarchic arrangement except at the level of the bulboventricular orifice, where the fibers tend to be aligned longitudinally, also being inserted into the fibrous ring. Minor differences, consisting mainly of the presence of extra bundles of fibers, were also observed among different individuals of the same species. The possible relationship between myocardial fiber architecture and ventricular shape is discussed. PMID:3578842

  1. A method for myocardial contraction force reconstruction for tissue viability assessment

    NASA Astrophysics Data System (ADS)

    Linte, Cristian A.; Peters, Terry M.; Samani, Abbas

    2006-03-01

    Myocardial infarction results in myocardial necrosis, usually caused by an imbalance in the oxygen supply and demand to myocardial tissue. To our knowledge there is no technique that can provide quantitative direct information concerning the intensity, extent and location of the infarction. Contraction forces generated by cardiac tissues represent a quantitative and direct measure of the myocardial functionality, since it is expected that infarcted tissue generate little or no contraction force. Our objective is to develop a biomechanics based reconstruction technique to image myocardial contraction forces, for the purpose of assessing the viability of cardiac tissues. This technique is designed to reconstruct the contraction forces by inverting myocardial tissue displacement data acquired throughout heart beat cycles using conventional imaging techniques. Recognizing that myocardial contraction force distribution is 3D, we assumed an axisymmetric myocardial geometry to demonstrate the concept. With this assumption, the inversion algorithm was developed and implemented in 2D space. As a preliminary analysis, a simulation involving a 2D representation of myocardial wall tissue was carried out. The tissue was modeled as a homogeneous material with isotropic and linear elastic material properties. Assuming an axisymmetric contraction force distribution, a finite element analysis was performed on the tissue model, and a 2D displacement field was generated. The developed inversion algorithm was then employed to reconstruct the force distribution, which was ultimately compared to the original force field. The reconstruction error, estimated as the difference between the two force fields and normalized by the magnitude of the reference distribution, averaged to +/-10%. Results demonstrate that our myocardial contraction force reconstruction algorithm is reasonably accurate and robust.

  2. Thallium-201 myocardial imaging: comparison of the high sensitivity and high resolution collimators

    SciTech Connect

    Wynant, G.E.

    1981-03-01

    Thallium-201 myocardial images of 20 patients undergoing treadmill exercise were evaluated as to the ability of the high sensitivity collimator (HSC) to reveal perfusion defects compared to images obtained using the high resolution collimator (HRC). The study acquired 200,000 count images in the anterior, 45/sup 0/ left anterior oblique, and left lateral projections. Average acquisition times were: HSC 3.41 min, and HRC 6.08 min. Fifteen patients who had clearly visible perfusion defects using the HRC showed degraded definition or appreciable loss of definition of the same defects when using the HSC.

  3. (1) Coronary Events Caused by Myocardial Bridge

    PubMed Central

    Yoko, Kawawa; Ehiichi, Kohda; Toshiharu, Ishii

    2009-01-01

    Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a “double-edged sword” on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal blood flow associated with coronary heart diseases (CHDs). High shear stress driven by MB compression causes the suppression of vascular permeability and vasoactive protein expression such as e-NOS and endothelin-1, which leads to the suppression of atherosclerosis in the LAD segment under the MB. However, despite the prevalent view of MB as benignancy by conventional coronary angiography (5-6% in frequency), with advance of imaging technique such as multislice spiral computed tomography [(MSCT); 16% in frequency], cardiologists are now frequently aware of symptomatic MB occurring not only in hospitalized patients, but also in young athletes free from atherosclerosis. Moreover, the large mass volume of MB muscle induces atherosclerosis evolution at the settled site in LAD proximal to MB and contributes to the occurrence of myocardial infarction. These events upon the coronary events result from the different pathophysiological mechanisms induced by contractile force of MB, which is solely determined just by the integration of anatomical properties of MB, such as the location, length and thickness of MB in an individual LAD. A recent MSCT provides the objective quantification of the anatomical variables that correlate with the histopathological results in relation to the occurrence of CHD. In this review, we therefore discuss the necessity to explore MB as a inherent chance anatomical risk factor for CHD. PMID:23555365

  4. Wall Turbulence.

    ERIC Educational Resources Information Center

    Hanratty, Thomas J.

    1980-01-01

    This paper gives an account of research on the structure of turbulence close to a solid boundary. Included is a method to study the flow close to the wall of a pipe without interferring with it. (Author/JN)

  5. Cave Walls

    A cave wall showing several cave formations, or speleothems. The larger formations at the bottom formed submerged in water, whereas the smaller formations at the top were exposed to air when they formed....

  6. Evaluation of diseased coronary arterial branches by polar representations of thallium-201 rotational myocardial imaging

    SciTech Connect

    Iino, T.; Toyosaki, N.; Katsuki, T.; Noda, T.; Natsume, T.; Yaginuma, T.; Hosoda, S.; Furuse, M.

    1987-09-01

    The perfusion territories in polar representations of stress Tl-201 rotational myocardial imaging in patients with angina pectoris who had one diseased coronary segment were analyzed. The lesions proximal or distal to the first major septal perforator in left anterior descending arteries were detected by the presence or absence of defects at the base of the anterior septum. Right coronary artery lesions were detected by the presence of defects at the basal posterior septum, in contrast to the preservation of myocardial uptake at this portion in lesions of the left circumflex artery. The specific defect patterns were detected in cases with lesions at the first diagonal, obtuse marginal, and posterolateral branches. Recognition of these defects in the polar maps allows detailed detection of diseased coronary arterial branches.

  7. [Myocardial ischemia and metabolic disorder].

    PubMed

    Yokota, Takashi; Kinugawa, Shintaro; Tsutsui, Hiroyuki

    2010-04-01

    During myocardial ischemia, the heart acutely adapts to the restricted supply of oxygen and substrates, and undergoes a dramatic switch from aerobic to anaerobic metabolism. However, this alteration in energy metabolism may cause calcium overload, the onset of mitochondrial permeability transition, and the activation of apoptotic cascades as well as reduced ATP synthesis in the myocardium, which contributes to a functional damage to the myocardium. Moreover, cardiac mitochondria are major sources of reactive oxygen species during ischemia, which may cause myocardial injury and contribute to poor recovery of myocardial dysfunction after reperfusion. Therefore, the modulation of mitochondrial function could be key therapeutics for cardiac protection during ischemia and reperfusion. PMID:20387551

  8. Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

    PubMed Central

    Okabe, Toshimasa; Julien, Howard M.; Kaliyadan, Antony G.; Siu, Henry

    2015-01-01

    In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment. PMID:26504446

  9. Clinical commissioning of an in vivo range verification system for prostate cancer treatment with anterior and anterior oblique proton beams

    NASA Astrophysics Data System (ADS)

    Hoesl, M.; Deepak, S.; Moteabbed, M.; Jassens, G.; Orban, J.; Park, Y. K.; Parodi, K.; Bentefour, E. H.; Lu, H. M.

    2016-04-01

    The purpose of this work is the clinical commissioning of a recently developed in vivo range verification system (IRVS) for treatment of prostate cancer by anterior and anterior oblique proton beams. The IRVS is designed to perform a complete workflow for pre-treatment range verification and adjustment. It contains specifically designed dosimetry and electronic hardware and a specific software for workflow control with database connection to the treatment and imaging systems. An essential part of the IRVS system is an array of Si-diode detectors, designed to be mounted to the endorectal water balloon routinely used for prostate immobilization. The diodes can measure dose rate as function of time from which the water equivalent path length (WEPL) and the dose received are extracted. The former is used for pre-treatment beam range verification and correction, if necessary, while the latter is to monitor the dose delivered to patient rectum during the treatment and serves as an additional verification. The entire IRVS workflow was tested for anterior and 30 degree inclined proton beam in both solid water and anthropomorphic pelvic phantoms, with the measured WEPL and rectal doses compared to the treatment plan. Gafchromic films were also used for measurement of the rectal dose and compared to IRVS results. The WEPL measurement accuracy was in the order of 1 mm and after beam range correction, the dose received by the rectal wall were 1.6% and 0.4% from treatment planning, respectively, for the anterior and anterior oblique field. We believe the implementation of IRVS would make the treatment of prostate with anterior proton beams more accurate and reliable.

  10. Clinical commissioning of an in vivo range verification system for prostate cancer treatment with anterior and anterior oblique proton beams.

    PubMed

    Hoesl, M; Deepak, S; Moteabbed, M; Jassens, G; Orban, J; Park, Y K; Parodi, K; Bentefour, E H; Lu, H M

    2016-04-21

    The purpose of this work is the clinical commissioning of a recently developed in vivo range verification system (IRVS) for treatment of prostate cancer by anterior and anterior oblique proton beams. The IRVS is designed to perform a complete workflow for pre-treatment range verification and adjustment. It contains specifically designed dosimetry and electronic hardware and a specific software for workflow control with database connection to the treatment and imaging systems. An essential part of the IRVS system is an array of Si-diode detectors, designed to be mounted to the endorectal water balloon routinely used for prostate immobilization. The diodes can measure dose rate as function of time from which the water equivalent path length (WEPL) and the dose received are extracted. The former is used for pre-treatment beam range verification and correction, if necessary, while the latter is to monitor the dose delivered to patient rectum during the treatment and serves as an additional verification. The entire IRVS workflow was tested for anterior and 30 degree inclined proton beam in both solid water and anthropomorphic pelvic phantoms, with the measured WEPL and rectal doses compared to the treatment plan. Gafchromic films were also used for measurement of the rectal dose and compared to IRVS results. The WEPL measurement accuracy was in the order of 1 mm and after beam range correction, the dose received by the rectal wall were 1.6% and 0.4% from treatment planning, respectively, for the anterior and anterior oblique field. We believe the implementation of IRVS would make the treatment of prostate with anterior proton beams more accurate and reliable. PMID:27002470

  11. Role of 123I-Iobenguane Myocardial Scintigraphy in Predicting Short-term Left Ventricular Functional Recovery: An Interesting Image

    PubMed Central

    Feola, Mauro; Chauvie, Stephane; Biggi, Alberto; Testa, Marzia

    2015-01-01

    123I-iobenguane myocardial scintigraphy (MIBG) has been shown to be a predictor of sudden cardiac mortality in patients with heart failure. One patient with recent anterior myocardial infarction (MI) treated with coronary angioplasty and having left ventricular ejection fraction (LVEF) of 30% underwent early MIBG myocardial scintigraphy/tetrofosmin single-photon emission computed tomography (SPECT) in order to help evaluate his eligibility for implantable cardioverter defibrillator (ICD). The late heart/mediastinum (H/M) ratio was calculated to be 1.32% and the washout rate was 1%. At 40-day follow-up after angioplasty, LVEF proved to be 32%, New York Heart Association (NYHA) class was still II–III, and an ICD was placed in order to reduce mortality from ventricular arrhythmias. MIBG myocardial scintigraphy might be a promising method for evaluating left ventricular recovery in post-MI patients. PMID:26664773

  12. NADH in situ laser fluorimetry: effect of pentobarbital on continuously monitored myocardial redox state

    SciTech Connect

    Renault, G.; Muffat-Joly, M.; Polianski, J.; Hardy, R.I.; Boutineau, J.L.; Duvent, J.L.; Pocidalo, J.J.

    1987-01-01

    NADH laser fluorimetry was applied to in situ monitoring of pentobarbital overload effect on myocardial redox state in rats. Experiments were carried out on open-chest rats anesthetized with pentobarbital. Use of very thin optical probes allowed measurements of NADH fluorescence directly within the myocardial wall. Quantitative analysis of fluorescent and backscattered light signals was made possible on-line. In 8 animals, a slow IV infusion of 6% pentobarbital (2 mg.min-1 for 10 min) induced an average twofold increase in NADH fluorescence, with constant return to baseline level prior to injection after a maximum period of 50 min. Thus, pentobarbital overload strongly affects the myocardial energetic state, and this effect was precisely evaluated with NADH fluorescence monitoring. In situ-monitored myocardial redox state variations during pentobarbital infusion can constitute a reference for similar studies on pharmacological agents aimed at protecting tissues against ischemic biochemical damages.

  13. Imaging of acute myocardial infarction in pigs with Indium-111 monoclonal antimyosin scintigraphy and MRI

    SciTech Connect

    ten Kate, C.I.; van Kroonenburgh, M.J.; Schipperheyn, J.J.; Doornbos, J.; Hoedemaeker, P.J.; Maes, A.; v.d. Nat, K.H.; Camps, J.A.; Huysmans, H.A.; Pauwels, E.K. )

    1990-07-01

    Indium-111 antimyosin F(ab')2 was used in a series of scintigraphic studies on experimentally induced myocardial infarctions in pigs. Antimyosin distribution recorded by planar images of in vivo pigs and by single photon emission computed tomography (SPECT) of excised hearts delineated areas of myocardial necrosis if infarct volume exceeded 3.3 cm3. Scintigraphic images were compared with magnetic resonance images (MRI) obtained from excised hearts and with photographs of slices of the hearts. Infarct size and localization determined with antimyosin were compared. The MR images, with or without gadolinium-DTPA (Gd-DTPA), of the in vivo pigs were all false-negative; some myocardial wall thinning and high bloodpool signals were visible. Results show that both the antimyosin and the MR technique are specific methods for the visualization of induced myocardial necrosis in this animal model. However, the use of antimyosin is limited to a period ranging from 24 to 72 hours after infarction.

  14. Altered phosphate metabolism in myocardial infarction: P-31 MR spectroscopy

    SciTech Connect

    Bottomley, P.A.; Herfkens, R.J.; Smith, L.S.; Bashore, T.M.

    1987-12-01

    The high-energy myocardial phosphate metabolism of four patients with acute anterior myocardial infarction after coronary angioplasty and drug therapy was evaluated with cardiac-gated phosphorus magnetic resonance (MR) depth-resolved surface coil spectroscopy (DRESS) 5-9 days after the onset of symptoms. Significant reductions (about threefold) in the phosphocreatine (PCr) to inorganic phosphate (Pi) ratio and elevations in the Pi to adenosine triphosphate (ATP) ratio were observed in endocardially or transmurally derived MR spectra when compared with values from epicardially displaced spectra and values from seven healthy volunteers (P less than .05). High-energy phosphate metabolites and Pi ratios did not vary significantly during the cardiac cycle in healthy volunteers. However, contamination of Pi resonances by phosphomonoester components, including blood 2,3-diphosphoglycerate, precluded accurate spectral quantification of Pi and pH. The results indicate that localized P-31 MR spectroscopy may be used to directly assess cellular energy reserve in clinical myocardial infarction and to evaluate metabolic response to interventions.

  15. Taurine and myocardial noradrenaline.

    PubMed

    Chahine, R; Hanna, J; Abou Khalil, K; Cheav, S L; Hatala, R; Bouchi, N; Mounayar, A

    1994-02-01

    Taurine (CAS 107-35-17) is an anticonvulsant used also as an adjunct in the treatment of cardiovascular disorders. Therefore, we studied its effects noradrenergic transmission in the isolated rabbit heart prelabelled with 3H-noradrenaline. At the concentrations of 1 and 10 mmol/l taurine treatment was without effect on the neuronal and extraneuronal uptake of noradrenaline by the myocardial tissue. At the highest concentration, it decreased the spontaneous release of the transmitter and enhanced its catabolism. Without any significant effect on tyramine-induced noradrenaline release, taurine decreased the release of the amine induced by dimethylphenylpiperazinium and nerve stimulation. These results suggested that taurine may reduce the peripheral sympathetic activity by accelerating noradrenaline catabolism and decreasing its release probably via its ability to prevent a rise of intracellular calcium ion. PMID:8147943

  16. Masquerades of myocardial infarction.

    PubMed Central

    Bean, W. B.

    1976-01-01

    I summarize these observations in Figure 1. It represents every person in a hypothetical population who has myocardial infarction. A large but unknown number, some believe almost half, never get help. Mobile coronary care units are reducing this group, but so far only a little. When the diagnosis is not understood the disease is not recognized. Then come discovery and popularization. Hereafter masquerades hide some cases and the diagnosis is missed. Somewhere fairly early the diagnostic fad leads to false positive diagnosis. As new techniques are discovered, perfected and mastered, false positive errors and masquerades leading to oversights diminish but still exist. All the skill and technical virtuosity in the world will not be applied if we do not think of the disease. When we think of it, even obscure cases may be resolved easily. PMID:960416

  17. Myocardial arterial spin labeling.

    PubMed

    Kober, Frank; Jao, Terrence; Troalen, Thomas; Nayak, Krishna S

    2016-01-01

    Arterial spin labeling (ASL) is a cardiovascular magnetic resonance (CMR) technique for mapping regional myocardial blood flow. It does not require any contrast agents, is compatible with stress testing, and can be performed repeatedly or even continuously. ASL-CMR has been performed with great success in small-animals, but sensitivity to date has been poor in large animals and humans and remains an active area of research. This review paper summarizes the development of ASL-CMR techniques, current state-of-the-art imaging methods, the latest findings from pre-clinical and clinical studies, and future directions. We also explain how successful developments in brain ASL and small-animal ASL-CMR have helped to inform developments in large animal and human ASL-CMR. PMID:27071861

  18. In vivo determination of acute myocardial ischemia based on photoacoustic imaging with a focused transducer

    NASA Astrophysics Data System (ADS)

    Li, Zhifang; Li, Hui; Chen, Haiyu; Xie, Wengming

    2011-07-01

    The location and ischemia extent are two important parameters for evaluating the acute myocardial ischemia (AMI). A focused-transducer-based photoacoustic imaging method was employed to assess time-dependent AMI. Our preliminary results show that the photoacoustic signal could identify the myocardium. The intensity and area of photoacoustic images of myocardium could be used for characterizing the ischemia extent and scope of myocardial ischemia. The results also imply that the intensity and area of photoacoustic images are the rapid fall of an exponential model with an increase of delaying time after the left anterior descending coronary artery (LAD) occlusion. These experimental results were consistent with the clinical characteristics. The findings suggest that the photoacoustic imaging be a potential tool for the real-time assessment of acute myocardial ischemia during surgical operation.

  19. Using a cardiac anchor to refine myocardial infarction surgery in the rat.

    PubMed

    Li, Qing; Morrison, Matthew S; Lim, Hae W

    2010-10-01

    Researchers have used the rat model of myocardial infarction for more than 20 y to successfully mimic the detrimental effects of coronary occlusion of the left anterior descending (LAD) coronary artery in humans. But researchers have published little about this surgery's intricacies or about the pathological progression of the disease after surgery. The authors describe a refined technique that uses a suture anchor at the apex of the heart, which allows easy and accurate placement of a ligature around the LAD. Furthermore, they detail the pathological timeline for the deposition of collagen in the injured left ventricle, a hallmark of myocardial infarction. Researchers can use this refined technique to easily create a rat myocardial infarction and use the pathophysiological markers described herein to follow disease progression. PMID:20859279

  20. Beneficial actions of the thromboxane receptor antagonist, AH-23,848, in acute myocardial ischemia.

    PubMed

    Brezinski, M E; Osborne, J A; Yanagisawa, A; Lefer, A M

    1987-11-01

    Thromboxane A2 (TxA2) production increases significantly during acute myocardial ischemia. Since TxA2 induces platelet aggregation, coronary vasoconstriction and has a direct cytolytic effect, thromboxane receptor antagonists would be expected to be beneficial in acute myocardial ischemia. A new thromboxane A2 receptor antagonist, AH-23,848, was studied in a cat model of acute myocardial ischemia. Myocardial ischemia was induced by ligation of the left anterior descending (LAD) coronary artery. Thirty minutes later, AH-23,848 or vehicle was given as a bolus (1 mg.kg-1) followed by a continuous infusion (1 mg.kg-1.h-1). AH-23,848 effectively reduced the S-T segment elevation while vehicle treated cats showed an increase. From direct myocardial biopsies, it was also seen that AH-23,848 prevented the loss of creatine kinase (CK) activity from the ischemic myocardium. Furthermore, the loss of amino-nitrogen compounds was also significantly reduced (p less than 0.05) by treatment with the receptor antagonist. This protective effect was not due to an indirect reduction of myocardial oxygen demand since blood pressure, heart rate or their product was unaltered by AH-23,848 administration. Moreover, the specificity of AH-23,848 to thromboxane receptors was confirmed in isolated cat coronary arteries and in cat platelets. These experiments demonstrate that blockade of the thromboxane receptor by AH-23,848 is an effective means of preventing acute myocardial ischemic damage in the cat, and thus thromboxane A2 plays a role in propagating the extension of ischemic damage during acute myocardial ischemia. PMID:2966270

  1. Effect of isometric horizontal abduction on pectoralis major and serratus anterior EMG activity during three exercises in subjects with scapular winging.

    PubMed

    Park, Kyung-Mi; Cynn, Heon-Seock; Yi, Chung-Hwi; Kwon, Oh-Yun

    2013-04-01

    The aim of this study was to determine the effect of isometric horizontal abduction using Thera-Band during three exercises (forward flexion, scaption, and wall push-up plus) in subjects with scapular winging by investigating the electromyographic (EMG) amplitude of the pectoralis major, serratus anterior and the pectoralis major/serratus anterior activity ratio. Twenty-four males with scapular winging participated in this study. The subjects performed the forward flexion, scaption, and wall push-up plus with and without isometric horizontal abduction using Thera-Band. Surface EMG was used to collect the EMG data of the pectoralis major and serratus anterior during the three exercises. Two-way repeated analyses of variance with two within-subject factors (isometric horizontal abduction condition and exercise type) were used to determine the statistical significance of pectoralis major and serratus anterior EMG activity and the pectoralis major/serratus anterior EMG activity ratio. Pectoralis major EMG activity was significantly lower during forward flexion and wall push-up plus with isometric horizontal abduction, and serratus anterior EMG activity was significantly greater with isometric horizontal abduction. Additionally, the pectoralis major/serratus anterior activity ratio was significantly lower during the forward flexion and wall push-up plus with isometric horizontal abduction. The results of this study suggest that isometric horizontal abduction using Thera-Band can be used as an effective method to facilitate the serratus anterior activity and to reduce excessive pectoralis major activity during exercises for activating serratus anterior. PMID:23332682

  2. Trifunctional transducer for myocardial monitoring

    NASA Technical Reports Server (NTRS)

    Culler, V. H.; Feldstein, C.; Lewis, G. W.; Meerbaum, S.

    1980-01-01

    Prototype myocardial transducer simultaneously monitors interal force, displacement, and thickness of heart muscle fiber within localized area of heart muscle. Transducer can be placed in area less than 1.5 by 4 mm.

  3. Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats

    PubMed Central

    Bozi, Luiz Henrique Marchesi; dos Santos Costa Maldonado, Izabel Regina; Baldo, Marcelo Perim; da Silva, Márcia Ferreira; Moreira, José Bianco Nascimento; Novaes, Rômulo Dias; Ramos, Regiane Maria Soares; Mill, José Geraldo; Brum, Patricia Chakur; Felix, Leonardo Bonato; Gomes, Thales Nicolau Prímola; Natali, Antônio José

    2013-01-01

    OBJECTIVES: The present study was performed to investigate 1) whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2) whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM), sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (p<0.05). RESULTS: Myocardial infarctions in exercise-trained animals resulted in a smaller myocardial infarction extension, a thicker infarcted wall and less collagen accumulation as compared to myocardial infarctions in sedentary animals. Myocardial infarction-induced left ventricular dilation and cardiac dysfunction, as evaluated by +dP/dt and -dP/dt, were both prevented by previous aerobic exercise training. Moreover, aerobic exercise training preserved cardiac myocyte shortening, improved the maximum shortening and relengthening velocities in infarcted hearts and enhanced responsiveness to calcium. CONCLUSION: Previous aerobic exercise training attenuated the cardiac dysfunction and structural deterioration promoted by myocardial infarction, and such benefits were associated with preserved cardiomyocyte morphological and contractile properties. PMID:23778353

  4. Stenting in acute myocardial infarction.

    PubMed

    Morice, M C; Lefèvre, T; Louvard, Y; Dumas, P; Loubeyre, C

    1998-06-01

    The limitations (recurrent ischaemia, restenosis, reocclusion) of percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (MI) can be addressed by stenting. The preliminary results of stenting are favourable (Stent PAMI, STENTIM, ZWOLLE trials). We report the results of the ICPS registry including 519 patients directly treated with angioplasty and stenting at the acute phase of myocardial infarction, with a repeat MI rate of 1% and a mortality of 3.7% in the non-shock group. PMID:10212498

  5. ST elevation without myocardial infarction

    PubMed Central

    Bitar, Zouheir Ibrahim; Swede, Mohammad; Almerri, Khaled

    2014-01-01

    Acute myocarditis may mimic myocardial infarction because the affected patients report ‘classical’ chest pain; the ECG changes and echocardiography are identical to those observed in acute coronary syndromes, and serum markers are increased. We describe a case with ST segment elevation on admission ECG, and coronary angiography was normal. Cardiac magnetic resonance with myocardial delayed enhancement sequences is a non-invasive alternative for diagnosing myocarditis. PMID:24711464

  6. ST elevation without myocardial infarction.

    PubMed

    Bitar, Zouheir Ibrahim; Swede, Mohammad; Almerri, Khaled

    2014-01-01

    Acute myocarditis may mimic myocardial infarction because the affected patients report 'classical' chest pain; the ECG changes and echocardiography are identical to those observed in acute coronary syndromes, and serum markers are increased. We describe a case with ST segment elevation on admission ECG, and coronary angiography was normal. Cardiac magnetic resonance with myocardial delayed enhancement sequences is a non-invasive alternative for diagnosing myocarditis. PMID:24711464

  7. Cardiac-Specific SOCS3 Deletion Prevents In Vivo Myocardial Ischemia Reperfusion Injury through Sustained Activation of Cardioprotective Signaling Molecules

    PubMed Central

    Nagata, Takanobu; Yasukawa, Hideo; Kyogoku, Sachiko; Oba, Toyoharu; Takahashi, Jinya; Nohara, Shoichiro; Minami, Tomoko; Mawatari, Kazutoshi; Sugi, Yusuke; Shimozono, Koutatsu; Pradervand, Sylvain; Hoshijima, Masahiko; Aoki, Hiroki; Fukumoto, Yoshihiro; Imaizumi, Tsutomu

    2015-01-01

    Myocardial ischemia reperfusion injury (IRI) adversely affects cardiac performance and the prognosis of patients with acute myocardial infarction. Although myocardial signal transducer and activator of transcription (STAT) 3 is potently cardioprotective during IRI, the inhibitory mechanism responsible for its activation is largely unknown. The present study aimed to investigate the role of the myocardial suppressor of cytokine signaling (SOCS)-3, an intrinsic negative feedback regulator of the Janus kinase (JAK)-STAT signaling pathway, in the development of myocardial IRI. Myocardial IRI was induced in mice by ligating the left anterior descending coronary artery for 1 h, followed by different reperfusion times. One hour after reperfusion, the rapid expression of JAK-STAT–activating cytokines was observed. We precisely evaluated the phosphorylation of cardioprotective signaling molecules and the expression of SOCS3 during IRI and then induced myocardial IRI in wild-type and cardiac-specific SOCS3 knockout mice (SOCS3-CKO). The activation of STAT3, AKT, and ERK1/2 rapidly peaked and promptly decreased during IRI. This decrease correlated with the induction of SOCS3 expression up to 24 h after IRI in wild-type mice. The infarct size 24 h after reperfusion was significantly reduced in SOCS3-CKO compared with wild-type mice. In SOCS3-CKO mice, STAT3, AKT, and ERK1/2 phosphorylation was sustained, myocardial apoptosis was prevented, and the expression of anti-apoptotic Bcl-2 family member myeloid cell leukemia-1 (Mcl-1) was augmented. Cardiac-specific SOCS3 deletion led to the sustained activation of cardioprotective signaling molecules including and prevented myocardial apoptosis and injury during IRI. Our findings suggest that SOCS3 may represent a key factor that exacerbates the development of myocardial IRI. PMID:26010537

  8. Anomalous origin of the left anterior descending artery from the pulmonary artery associated with bicuspid aortic valve and aortic coarctation.

    PubMed

    Clarke, Andrew J B; Radford, Dorothy J; Jalali, Homayoun

    2003-01-01

    A 15-year-old boy presented with exertional palpitations and chest pain. Investigation revealed anomalous origin of his left anterior descending coronary artery from his pulmonary trunk causing myocardial ischaemia. He previously had aortic coarctation repair with known aortic root dilation and a bicuspid aortic valve. His left anterior descending artery was implanted into the aortic root using a Gortex interposition conduit. This represents an interesting combination of cardiac abnormalities for which repair required consideration of the requirement of further surgery in the future. PMID:16352110

  9. Cardioprotection of vitexin on myocardial ischemia/reperfusion injury in rat via regulating inflammatory cytokines and MAPK pathway.

    PubMed

    Dong, Liu-Yi; Li, Sheng; Zhen, Yi-Lan; Wang, Ya-Nan; Shao, Xu; Luo, Zhi-Gang

    2013-01-01

    This study was conducted to demonstrate myocardial protective effects and possible underlying mechanisms of vitexin on myocardial ischemia/reperfusion (I/R) injury in rats. Occluding the anterior descending artery for 30 min and restoring blood perfusion for 60 min in rat established a model of myocardial I/R. The elevation of the ST segment of Electrocardiograph (ECG) was observed. The infarct size of the rat heart was assessed by triphenyltetrazolium chloride staining (TTC). LDH, CK, SOD activities and MDA content were determined. An immunohistochemical analysis was applied to measure the expression of myocardial NF-κBp65 and TNF-α. ERK/phospho-ERKand c-Jun/phospho-c-Jun protein expression was examined via Western Blot. Vitexin significantly reduced the elevation of the ST segment of ECG and myocardial infarct size. LDH and CK activities and MDA content were attenuated in serum, while SOD activity was markedly enhanced. Vitexin significantly attenuated I/R-induced increases of myocardial NF-κB and TNF-α. Moreover, Western Blot analysis presented that vitexin markedly enhanced the expression of phospho-ERK and weakened the expression of phospho-c-Jun compared to I/R group. The significant protective effect against myocardial ischemical/reperfusion injury in rat, which is exhibited by vitexin, may be related to its antioxidative and anti-inflammatory effects by regulating inflammatory cytokines and the MAPK pathway. PMID:24228599

  10. Relation between regional distribution of /sup 201/Tl and myocardial blood flow in normal, acutely ischemic, and infarcted myocardium

    SciTech Connect

    Chu, A.; Murdock, R.H. Jr.; Cobb, F.R.

    1982-11-01

    Myocardial localization of /sup 201/Tl was compared with direct measurements of myocardial perfusion in normal, acutely ischemic, and recently infarcted myocardium. Studies were performed in 6 chronically instrumented dogs that were subjected to myocardial infarction by occlusion of the proximal left circumflex coronary artery. Four days after myocardial infarction, /sup 201/Tl and 9 +/- 1 micrometer /sup 95/Nb-labelled microspheres were injected simultaneously after acute left anterior descending coronary arterial occlusion; the animals were killed 5 minutes later and the entire left ventricle was sectioned into 1 to 2 g samples. Regression analyses between /sup 201/Tl activity and regional myocardial blood flow using all myocardial samples demonstrated a very close linear relation in each dog; r values were 0.98 or greater, indicating that the initial localization of /sup 201/Tl in acutely ischemic and recently infarcted myocardium as a function of regional blood flow was essentially identical. Consequently, in each dog the regional distribution of /sup 201/Tl closely approximated myocardial perfusion over a wide range of blood flow and potentially different local metabolic conditions that may be encountered in the clinical use of the isotope.

  11. Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction

    EPA Science Inventory

    Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM2....

  12. 'Stucco' Walls

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This projected mosaic image, taken by the microscopic imager, an instrument located on the Mars Exploration Rover Opportunity 's instrument deployment device, or 'arm,' shows the partial clotting or cement-like properties of the sand-sized grains within the trench wall. The area in this image measures approximately 3 centimeters (1.2 inches) wide and 5 centimeters (2 inches) tall.(This image also appears as an inset on a separate image from the rover's navigation camera, showing the location of this particular spot within the trench wall.)

  13. Scorpion envenomation-induced acute thrombotic inferior myocardial infarction.

    PubMed

    Baykan, Ahmet Oytun; Gür, Mustafa; Acele, Armağan; Şeker, Taner; Çaylı, Murat

    2016-01-01

    The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome. PMID:26875137

  14. Protective mechanism of quercetin on acute myocardial infarction in rats.

    PubMed

    Li, B; Yang, M; Liu, J W; Yin, G T

    2016-01-01

    To investigate the protective mechanism of quercetin on acute myocardial infarction (AMI) rats, an AMI rat model was established by ligating the left coronary anterior descending branch. The rats were randomly divided into the model group and low- and high-dose quercetin groups. The control group comprised sham-operated rats. The rats in the low- and high-dose quercetin groups were administered 100 and 400 mg/kg quercetin, respectively, by gavage. The rats in the control and model groups were administered isometric normal saline once daily for one week. The mRNA and protein levels of TNF-α and IL-1β in the myocardial tissue of rats were detected in each group by real time polymerase chain reaction and enzyme-linked immunosorbent assay. Malondialdehyde (MDA) content in the myocardial tissue and superoxide dismutase (SOD) and catalase (CAT) activities were detected using a colorimetric method. The level of apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling. Compared with those in the control group, the mRNA and protein levels of TNF-α, IL-1β and MDA content in the model, low-, and high-dose groups significantly increased. SOD and CAT activities decreased significantly. The cell apoptosis index increased significantly  (P < 0.05). Compared with those in the model group, the mRNA and protein levels of TNF-α and IL-1β and MDA content in myocardial tissue of rats in the low-dose and high-dose groups decreased significantly. SOD and CAT activities increased significantly. The cell apoptosis index significantly reduced (P < 0.05). In conclusion, quercetin has significant anti-inflammatory, antioxidant, and anti-apoptotic effects on AMI rats and can effectively protect against myocardium damage. PMID:26985950

  15. Update on anterior ankle impingement.

    PubMed

    Vaseenon, Tanawat; Amendola, Annunziato

    2012-06-01

    Anterior ankle impingement results from an impingement of the ankle joint by a soft tissue or osteophyte formation at the anterior aspect of the distal tibia and talar neck. It often occurs secondary to direct trauma (impaction force) or repetitive ankle dorsiflexion (repetitive impaction and traction force). Chronic ankle pain, swelling, and limitation of ankle dorsiflexion are common complaints. Imaging is valuable for diagnosis of the bony impingement but not for the soft tissue impingement, which is based on clinical findings. MR imaging and MR arthrography are helpful in doubtful diagnoses and the identification of associated injuries. Recommended methods for initial management include rest, physical therapy, and shoe modification. If nonoperative treatment fails, arthroscopic bony or soft tissue debridement both offer significant symptomatic relief with long-term positive outcomes in cases that have no significant arthritic change, associated ligament laxity, and chondral lesion. PMID:22403038

  16. Quantification of Myocardial Strain at Early Systole in Mouse Heart: Restoration of Undeformed Tagging Grid with Single-Point HARP

    PubMed Central

    Li, Wei; Yu, Xin

    2010-01-01

    Purpose To develop accurate strain and torsion quantification method for the assessment of myocardial contraction in mice by MRI tagging. Materials and Methods Ventricular wall motion at baseline and during β-adrenergic stimulation was assessed in mice using MRI tagging. Myocardial strain and torsion were quantified using finite element analysis method. A harmonic phase (HARP) based method was developed for the restoration of undeformed taglines for more accurate calculation of myocardial wall strain and torsion. Results Myocardial deformation was observed at early systole (< 20 ms after QRS) both at baseline and during β-adrenergic stimulation. The HARP-based method allowed robust restoration of undeformed taglines that can be used as the reference in finite element analysis of the tagged images. Without such correction for myocardial deformation in the reference image, inaccuracy in strain quantification underestimated significant strain development at early systole in dobutamine-stimulated hearts. Conclusion The HARP-based method developed in the current study enabled automated restoration of undeformed taglines in mouse hearts, leading to more accurate calculation of myocardial wall strain and torsion during dobutamine stimulation. PMID:20815058

  17. Wall shear stress in intracranial aneurysms and adjacent arteries☆

    PubMed Central

    Wang, Fuyu; Xu, Bainan; Sun, Zhenghui; Wu, Chen; Zhang, Xiaojun

    2013-01-01

    Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries. PMID:25206394

  18. Wall shear stress in intracranial aneurysms and adjacent arteries.

    PubMed

    Wang, Fuyu; Xu, Bainan; Sun, Zhenghui; Wu, Chen; Zhang, Xiaojun

    2013-04-15

    Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries. PMID:25206394

  19. Wall Art

    ERIC Educational Resources Information Center

    McGinley, Connie Q.

    2004-01-01

    The author of this article, an art teacher at Monarch High School in Louisville, Colorado, describes how her experience teaching in a new school presented an exciting visual challenge for an art teacher--monotonous brick walls just waiting for decoration. This school experienced only minimal instances of graffiti, but as an art teacher, she did…

  20. Wall Art

    ERIC Educational Resources Information Center

    McGinley, Connie Q.

    2004-01-01

    The author of this article, an art teacher at Monarch High School in Louisville, Colorado, describes how her experience teaching in a new school presented an exciting visual challenge for an art teacher--monotonous brick walls just waiting for decoration. This school experienced only minimal instances of graffiti, but as an art teacher, she did

  1. Wall Covering

    NASA Technical Reports Server (NTRS)

    1978-01-01

    The attractive wall covering shown below is one of 132 styles in the Mirror Magic II line offered by The General Tire & Rubber Company, Akron, Ohio. The material is metallized plastic fabric, a spinoff from space programs. Wall coverings are one of many consumer applications of aluminized plastic film technology developed for NASA by a firm later bought by King-Seeley Thermos Company, Winchester, Massachusetts, which now produces the material. The original NASA use was in the Echo 1 passive communications satellite, a "space baloon" made of aluminized mylar; the high reflectivity of the metallized coating enabled relay of communications signals from one Earth station to another by "bouncing" them off the satellite. The reflectivity feature also made the material an extremely efficient insulator and it was subsequently widely used in the Apollo program for such purposes as temperature control of spacecraft components and insulation of tanks for fuels that must be maintained at very low temperatures. I Used as a wall covering, the aluminized material offers extra insulation, reflects light and I resists cracking. In addition to General Tire, King-Seeley also supplies wall covering material to Columbus Coated Fabrics Division of Borden, Incorporated, Columbus, Ohio, among others.

  2. Chlorogenic acid attenuates ventricular remodeling after myocardial infarction in mice.

    PubMed

    Kanno, Yoshinori; Watanabe, Ryo; Zempo, Hirofumi; Ogawa, Masahito; Suzuki, Jun-Ichi; Isobe, Mitsuaki

    2013-01-01

    Chlorogenic acid (CGA), which is a key component of coffee, has many biological effects such as anti-inflammation activity. However, the effects of CGA on ventricular remodeling after myocardial ischemia have not been well investigated. To test the hypothesis that CGA can attenuate chronic ventricular remodeling after myocardial ischemia, we orally administered CGA to murine myocardial ischemia models. Seven to nine week-old C57BL/6 mice were used. A myocardial infarction (MI) model was produced by permanent ligation of the left anterior descending coronary artery (LAD) using an 8-0 suture passed under the arteries. These mice were randomly assigned into 4 groups in each experimental model. Some MI mice were supplemented orally with CGA (30 mg/kg/day, MI+CGA group, n = 13) as a CGAtreated MI group, and other MI mice received vehicle (MI+vehicle group, n = 11) as a vehicle-treated MI group. Shamoperated mice without MI also received vehicle (Sham+vehicle group, n = 3) as a sham group, and sham-operated mice without MI received CGA (30 mg/kg/day, Sham+CGA group, n = 8) as a Sham+CGA group. Just before sacrifice on day 14, we measured blood pressure and heart rate and performed echocardiography. We obtained 3 transverse sections per heart for histopathologic examination. There were no differences in body weight, heart rate, or blood pressure among the groups on day 14. The vehicle-treated MI group showed significantly impaired left ventricular contraction compared to the sham-operated group. However, the CGA-treated MI group showed significantly improved ventricular contraction compared to the vehicle-treated MI group. Severe myocardial fibrosis with enhanced macrophage infiltration was observed in the vehicle-treated ischemia group on day 14. CGA attenuated these fibrotic changes with suppressed macrophage infiltration without systemic adverse effects. CGA may effectively suppress chronic ventricular remodeling after myocardial ischemia because it is critically involved in the suppression of macrophage infiltration. PMID:23774243

  3. Automatic implantable cardioverter/defibrillator discharges and acute myocardial injury

    SciTech Connect

    Avitall, B.; Port, S.; Gal, R.; McKinnie, J.; Tchou, P.; Jazayeri, M.; Troup, P.; Akhtar, M. )

    1990-05-01

    Multiple defibrillations by the automatic implantable cardioverter/defibrillator (AICD) have been reported to result in localized epicardial damage. No data exist, however, regarding whether this damage can be detected in the clinical setting or whether it interferes with the detection of true myocardial infarction. Forty-nine patients who received defibrillations by patch electrodes were studied prospectively. We attempted to document the presence of myocardial injury with the following three commonly used modalities for the detection of myocardial infarction: serial electrocardiographic changes, serial creatine phosphokinase (CPK) and CPK-MB release, and technetium 99m pyrophosphate scanning. Fifteen patients received defibrillations by AICD patches at the time of AICD generator replacement. Nine patients received defibrillations at the time of new AICD lead placement. The average total energy delivered was 85 +/- 29 J. None of these patients had detectable myocardial injury. Ten patients had defibrillations by the AICD patches at the time of bypass operation. One patient in this group developed acute myocardial infarction in the inferior wall after posterior descending coronary bypass operation, as detected by electrocardiogram, 99mTc pyrophosphate scanning, and CPK-MB analysis. Fifteen patients were evaluated for spontaneous AICD discharges. Thirteen had a maximum of five consecutive shocks, and cumulative energy delivered was not greater than 330 J. None of these patients had detectable injury. Two patients had CPK-MB release of 15.3% and 7.5%, respectively. One of these patients had a positive 99mTc pyrophosphate scan. These two patients received 12 and 17 rapid and consecutive AICD discharges, respectively, with cumulative delivered energy of 360 and 510 J, respectively.

  4. The zebrafish heart regenerates after cryoinjury-induced myocardial infarction

    PubMed Central

    2011-01-01

    Background In humans, myocardial infarction is characterized by irreversible loss of heart tissue, which becomes replaced with a fibrous scar. By contrast, teleost fish and urodele amphibians are capable of heart regeneration after a partial amputation. However, due to the lack of a suitable infarct model, it is not known how these animals respond to myocardial infarction. Results Here, we have established a heart infarct model in zebrafish using cryoinjury. In contrast to the common method of partial resection, cryoinjury results in massive cell death within 20% of the ventricular wall, similar to that observed in mammalian infarcts. As in mammals, the initial stages of the injury response include thrombosis, accumulation of fibroblasts and collagen deposition. However, at later stages, cardiac cells can enter the cell cycle and invade the infarct area in zebrafish. In the subsequent two months, fibrotic scar tissue is progressively eliminated by cell apoptosis and becomes replaced with a new myocardium, resulting in scarless regeneration. We show that tissue remodeling at the myocardial-infarct border zone is associated with accumulation of Vimentin-positive fibroblasts and with expression of an extracellular matrix protein Tenascin-C. Electrocardiogram analysis demonstrated that the reconstitution of the cardiac muscle leads to the restoration of the heart function. Conclusions We developed a new cryoinjury model to induce myocardial infarction in zebrafish. Although the initial stages following cryoinjury resemble typical healing in mammals, the zebrafish heart is capable of structural and functional regeneration. Understanding the key healing processes after myocardial infarction in zebrafish may result in identification of the barriers to efficient cardiac regeneration in mammals. PMID:21473762

  5. Innate immune response after acute myocardial infarction and pharmacomodulatory action of tacrolimus in reducing infarct size and preserving myocardial integrity

    PubMed Central

    2013-01-01

    Background This study investigated the association between innate immune reaction and myocardial damage after acute myocardial infarction (AMI) and anti-inflammatory role of tacrolimus in reducing infarct size. Male mini-pigs (n=18) were equally categorized into sham control (SC), untreated AMI (by ligation of left anterior descending coronary artery), and AMI-Tacrolimus (AMI-Tac) (0.5 mg intra-coronary injection 30 minutes post-AMI). Cardiac magnetic resonance imaging (MRI) was performed at post-AMI days 2, 5 and 21 before sacrificing the animals. Results By post-AMI day 21, left ventricular ejection fraction (LVEF) was lowest in untreated AMI animals, significantly higher in SC than in AMI-Tac group (all p<0.003). Infarct areas at basal, middle, and apical levels, numbers of CD14+ and iNOS+ cells in infarct area (IA) and peri-IA, and protein expression of CD14, CD68, and Ly6g from circulating inflammatory cells showed an opposite pattern compared with that of LVEF in all groups (all p<0.005). Protein expressions of MCP-1, MIP-1, TNF-α, NF-κB, iNOS, and IL-12 in IA and peri-IA exhibited an identical pattern compared to that of CD14, CD68, and Ly6g from circulating inflammatory cells (all p<0.01). Expressions of myocardial damage biomarkers in IA and peri-IA [γ-H2AX, β-myosin heavy chain (MHC), Smad3, TGF-β] were highest in AMI and higher in AMI-Tac than in SC, whereas expressions of myocardial integrity biomarkers (connexin43, mitochondrial cytochrome-C, α-MHC, BMP-2, Smad1/5) were opposite to those of damage biomarkers (all p<0.001). Conclusion Innate immune responses were markedly augmented and LVEF was significantly reduced after AMI but were remarkably improved after tacrolimus treatment. PMID:24165293

  6. Monocytes in myocardial infarction.

    PubMed

    Dutta, Partha; Nahrendorf, Matthias

    2015-05-01

    Myocardial infarction (MI) is the leading cause of death in developed countries. Though timely revascularization of the ischemic myocardium and current standard therapy reduce acute mortality after MI, long-term morbidity and mortality remain high. During the first 1 to 2 weeks after MI, tissues in the infarcted myocardium undergo rapid turnover, including digestion of extracellular matrix and fibrosis. Post-MI repair is crucial to survival. Monocytes recruited to the infarcted myocardium remove debris and facilitate the repair process. However, exaggerated inflammation may also impede healing, as demonstrated by the association between elevated white blood cell count and in-hospital mortality after MI. Monocytes produced in the bone marrow and spleen enter the blood after MI and are recruited to the injured myocardium in 2 phases. The first phase is dominated by Ly-6c(high) monocytes and the second phase by Ly-6c(low) monocytes. Yet the number of Ly6C(low) monocytes recruited to the infarct is much lower, and Ly6C(high) monocytes can differentiate to Ly6C(low) macrophages in later healing stages. Understanding the signals regulating monocytosis after MI will help design new therapies to facilitate cardiac healing and limit heart failure. PMID:25792449

  7. Differential MR Delayed Enhancement Patterns of Chronic Myocardial Infarction between Extracellular and Intravascular Contrast Media

    PubMed Central

    Wang, Jian; Xiang, Bo; Lin, Hung Yu; Liu, Hongyu; Freed, Darren; Arora, Rakesh C.; Tian, Ganghong

    2015-01-01

    Objectives Because the distribution volume and mechanism of extracellular and intravascular MR contrast media differ considerably, the enhancement pattern of chronic myocardial infarction with extracellular or intravascular media might also be different. This study aims to investigate the differences in MR enhancement patterns of chronic myocardial infarction between extracellular and intravascular contrast media. Materials and Methods Twenty pigs with myocardial infarction underwent cine MRI, first pass perfusion MRI and delayed enhancement MRI with extracellular or intravascular media at four weeks after coronary occlusion. Myocardial blood flow (MBF) was determined with microsphere measurement. The infarction histopathological changes were evaluated by hematoxylin and eosin staining and Masson's trichrome method. Results Cine MRI revealed the reduced wall thickening in chronic infarction compared with normal myocardium. Moreover, significant wall thinning in chronic infarction was observed in cine MRI. Peak first-pass signal intensity didnt significantly differ between chronic infarction and normal myocardium no matter what kinds of contrast media. At the following delayed enhancement phase, extracellular media-enhanced signal intensity was significantly higher in chronic infarction than in normal myocardium. Conversely, intravascular media-enhanced signal intensity was almost equivalent among chronic infarction and normal myocardium. At four weeks after infarction, MBF in chronic infarction approached to that in normal myocardium. Large thick-walled vessels were detected at peri-infarction zones. The cardiomyocytes were replaced by scar tissue consisting of dilated blood vessels and discrete fibers of collagen. Conclusions Chronic infarction was characterized by the significantly reduced wall thickening and the definite wall thinning. First-pass myocardial perfusion defect was not detected in chronic infarction with two media due to the significantly recovered MBF and well-developed collateral vessels. Infarction remodeling enlarged the extracellular compartment, which was available for extracellular media but not accessible to intravascular media. Extracellular media identified chronic infarction as the hyper-enhancement; nonetheless, intravascular media didnt provide delayed enhancement. PMID:25816056

  8. Myocardial perfusion as assessed by thallium-201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients

    SciTech Connect

    Hurford, W.E.; Lynch, K.E.; Strauss, H.W.; Lowenstein, E.; Zapol, W.M. )

    1991-06-01

    Patients who cannot be separated from mechanical ventilation (MV) after an episode of acute respiratory failure often have coexisting coronary artery disease. The authors hypothesized that increased left ventricular (LV) wall stress during periods of spontaneous ventilation (SV) could alter myocardial perfusion in these patients. Using thallium-201 (201TI) myocardial scintigraphy, the authors studied the occurrence of myocardial perfusion abnormalities during periods of SV in 15 MV-dependent patients (nine women, six men; aged 71 {plus minus} 7 yr, mean {plus minus} SD). Fourteen of these patients were studied once with 201TI myocardial scintigraphy during intermittent mechanical ventilation (IMV) and again on another day, after at least 10 min of SV through a T-piece. One patient was studied during SV only. Thirteen of 14 of the patients (93%) studied during MV had abnormal patterns of initial myocardial 201TI uptake, but only 1 patient demonstrated redistribution of 201TI on delayed images. The remainder of the abnormalities observed during MV were fixed defects. SV produced significant alterations of myocardial 201TI distribution or transient LV dilation, or both, in 7 of the 15 patients (47%). Four patients demonstrated new regional decreases of LV myocardial thallium concentration with redistribution of the isotope on delayed images. The patient studied only during SV also had myocardial 201TI defects with redistribution. Five patients (3 also having areas of 201TI redistribution) had transient LV dilation during SV.

  9. Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases

    PubMed Central

    Sadrizadeh, Ali; Soltani, Ehsan; Abili, Mehdi; Dehghanian, Paria

    2015-01-01

    Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated. Case Report: Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem Conclusion: In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested. PMID:25938087

  10. Intravenous Administration of Lycopene, a Tomato Extract, Protects against Myocardial Ischemia-Reperfusion Injury

    PubMed Central

    Tong, Chao; Peng, Chuan; Wang, Lianlian; Zhang, Li; Yang, Xiaotao; Xu, Ping; Li, Jinjin; Delplancke, Thibaut; Zhang, Hua; Qi, Hongbo

    2016-01-01

    Background: Oral uptake of lycopene has been shown to be beneficial for preventing myocardial ischemia-reperfusion (I/R) injury. However, the strong first-pass metabolism of lycopene influences its bioavailability and impedes its clinic application. In this study, we determined an intravenous (IV) administration dose of lycopene protects against myocardial infarction (MI) in a mouse model, and investigated the effects of acute lycopene administration on reactive oxygen species (ROS) production and related signaling pathways during myocardial I/R. Methods: In this study, we established both in vitro hypoxia/reoxygenation (H/R) cell model and in vivo regional myocardial I/R mouse model by ligating left anterior artery descending. TTC dual staining was used to assess I/R induced MI in the absence and presence of acute lycopene administration via tail vein injection. Results: Lycopene treatment (1 μM) before reoxygenation significantly reduced cardiomyocyte death induced by H/R. Intravenous administration of lycopene to achieve 1 μM concentration in circulating blood significantly suppressed MI, ROS production, and JNK phosphorylation in the cardiac tissue of mice during in vivo regional I/R. Conclusion: Elevating circulating lycopene to 1 μM via IV injection protects against myocardial I/R injury through inhibition of ROS accumulation and consequent inflammation in mice. PMID:26950150

  11. Myocardial perfusion imaging for detection of silent myocardial ischemia

    SciTech Connect

    Beller, G.A.

    1988-04-21

    Despite the widespread use of the exercise stress test in diagnosing asymptomatic myocardial ischemia, exercise radionuclide imaging remains useful for detecting silent ischemia in numerous patient populations, including those who are totally asymptomatic, those who have chronic stable angina, those who have recovered from an episode of unstable angina or an uncomplicated myocardial infarction, and those who have undergone angioplasty or received thrombolytic therapy. Studies show that thallium scintigraphy is more sensitive than exercise electrocardiography in detecting ischemia, i.e., in part, because perfusion defects occur more frequently than ST depression and before angina in the ischemic cascade. Thallium-201 scintigraphy can be performed to differentiate a true- from a false-positive exercise electrocardiographic test in patients with exercise-induced ST depression and no angina. The development of technetium-labeled isonitriles may improve the accuracy of myocardial perfusion imaging. 11 references.

  12. MYOCARDIAL AKT: THE OMNIPRESENT NEXUS

    PubMed Central

    Sussman, Mark A.; Völkers, Mirko; Fischer, Kimberlee; Bailey, Brandi; Cottage, Christopher T.; Din, Shabana; Gude, Natalie; Avitabile, Daniele; Alvarez, Roberto; Sundararaman, Balaji; Quijada, Pearl; Mason, Matt; Konstandin, Mathias H.; Malhowski, Amy; Cheng, Zhaokang; Khan, Mohsin; McGregor, Michael

    2013-01-01

    One of the greatest examples of integrated signal transduction is revealed by examination of effects mediated by AKT kinase in myocardial biology. Positioned at the intersection of multiple afferent and efferent signals, AKT exemplifies a molecular sensing node that coordinates dynamic responses of the cell in literally every aspect of biological responses. The balanced and nuanced nature of homeostatic signaling is particularly essential within the myocardial context, where regulation of survival, energy production, contractility, and response to pathological stress all flow through the nexus of AKT activation or repression. Equally important, the loss of regulated AKT activity is primarily the cause or consequence of pathological conditions leading to remodeling of the heart and eventual decompensation. This review presents an overview compendium of the complex world of myocardial AKT biology gleaned from more than a decade of research. Summarization of the widespread influence that AKT exerts upon myocardial responses leaves no doubt that the participation of AKT in molecular signaling will need to be reckoned with as a seemingly omnipresent regulator of myocardial molecular biological responses. PMID:21742795

  13. Acute myocardial infarction due to coronary thrombosis caused by blunt chest trauma

    PubMed Central

    Treuth, Gregory M; Baibars, Motaz; Alraiyes, Abdul Hamid; Alraies, M Chadi

    2014-01-01

    A 65-year-old man presented to the emergency department following an anterior chest trauma. He had significant chest pain and chest X-ray was significant for revealed multiple rib fractures and negative. CT scan of the chest ruled out pulmonary embolism or aortic dissection. However, few hours later he developed hypotension requiring admission to medical intensive care unit and intravenous vasopressors. Further workup showed ST elevation myocardial infarction involving the anterior ECG leads. Emergent coronary angiography was performed with intervention to the mid-left anterior descending occlusion. Cardiogenic shock resolved and patient was discharged few days later. One-year follow-up with echocardiogram showed stable ischaemic cardiomyopathy with improved left ventricular ejection fraction to 50%. PMID:24769662

  14. How reliable is myocardial imaging in the diagnosis of acute myocardial infarction

    SciTech Connect

    Willerson, J.T.

    1983-01-01

    Myocardial scintigraphic techniques available presently allow a sensitive and relatively specific diagnosis of acute myocardial infarction when they are used correctly, although every technique has definite limitations. Small myocardial infarcts (less than 3 gm.) may be missed, and there are temporal limitations in the usefulness of the scintigraphic techniques. The development of tomographic methodology that may be used with single-photon radionuclide emitters (including technetium and /sup 201/Tl will allow the detection of relatively small abnormalities in myocardial perfusion and regions of myocardial infarction and will help to provide a more objective interpretation of the myocardial scintigrams. The use of overlay techniques allowing simultaneous assessment of myocardial perfusion, infarct-avid imaging, and radionuclide ventriculograms will provide insight into the relevant aspects of the extent of myocardial damage, the relationship of damage to myocardial perfusion, and the functional impact of myocardial infarction on ventricular performance.

  15. Penehyclidine Hydrochloride Preconditioning Provides Cardioprotection in a Rat Model of Myocardial Ischemia/Reperfusion Injury

    PubMed Central

    Lin, Duomao; Ma, Jun; Xue, Yanyan; Wang, Zhaoqi

    2015-01-01

    To investigate the impacts and related mechanisms of penehyclidine hydrochloride (PHC) on ischemia/reperfusion (I/R)-induced myocardial injury. A rat model of myocardial I/R injury was established by the ligation of left anterior descending coronary artery for 30 min followed by 3 h perfusion. Before I/R, the rats were pretreated with or without PHC. Cardiac function was measured by echocardiography. The activities/levels of myocardial enzymes, oxidants and antioxidant enzymes were detected. Evans blue/TTC double staining was performed to assess infarct size. Cardiomyocyte apoptosis was evaluated by TUNEL assay. The release of inflammatory cytokines and inflammatory mediators was detected by ELISA. Western blot was performed to analyze the expression of COX-2, IκB, p-IκB and NF-κB. Meanwhile, the rats were given a single injection of H-PHC before I/R. The effects of PHC on myocardial infarct and cardiac function were investigated after 7 days post-reperfusion. We found that PHC remarkably improved cardiac function, alleviated myocardial injury by decreasing myocardial enzyme levels and attenuated oxidative stress in a dose-dependent manner. Additionally, PHC preconditioning significantly reduced infarct size and the apoptotic rate of cardiomyocytes. Administration of PHC significantly decreased serum TNF-α, IL-1β, IL-6 and PGE2 levels and myocardium COX-2 level. Meanwhile, the expression levels of p-IκB and NF-κB were downregulated, while IκB expression was upregulated. H-PHC also exerted long-term cardioprotection in a rat model of I/R injury by decreasing infarct size and improving cardiac function. These results suggest that PHC can efficiently protect the rats against I/R-induced myocardial injury. PMID:26632817

  16. Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion.

    PubMed

    He, Ben; Ding, Song; Qiao, Zhiqing; Gao, Lincheng; Wang, Wei; Ge, Heng; Shen, Xuedong; Pu, Jun

    2016-05-01

    To investigate the impact of microvascular dysfunction assessed by angiography on myocardial deformation assessed by two-dimensional speckle-tracking echocardiography in ST-segment elevation myocardial infarction (STEMI). A total of 121 STEMI patients who received primary percutaneous coronary intervention were included. Thrombolysis in myocardial infarction, Myocardial Perfusion Frame Count (TMPFC), a novel angiographic method to assess myocardial perfusion, was used to evaluate microvascular dysfunction. Two-dimensional speckle-tracking echocardiography was performed at 3-7 days after reperfusion. The infarction related regional longitudinal (RLS) strains as well as circumferential (RCS) and radial (RRS) ones, along with global longitudinal, circumferential (GCS), and radial (GRS) strains were measured. Patients with microvascular dysfunction had decreased peak amplitude of RLS (p = 0.012), RCS (p < 0.001), RRS (p = 0.012) at the regional level and decreased peak amplitude of GCS (p = 0.005), GRS (p = 0.012) at the global level. The RCS to RLS and RCS to RRS ratios were significantly different between patients without than with microvascular dysfunction (1.28 ± 0.31 vs. 1.07 ± 0.47, p = 0.027 and 0.69 ± 0.33 vs. 0.56 ± 0.28, p = 0.047). Receiver operator characteristics curves identified a cutoff value of 94 frames for TMPFC to differentiate between normal and abnormal wall motion score index in the sub-acute phase of STEMI (AUC = 0.72; p < 0.001). In the sub-acute phase of STEMI, the presence of microvascular dysfunction in infarcted tissue relates to reduced global and regional myocardial deformation. RCS alterations were more significant than RLS and RRS between patients with than without microvascular dysfunction. TMPFC was useful to predict left ventricular systolic dysfunction in the sub-acute phase of STEMI. PMID:26803498

  17. Is arterial wall-strain stiffening an additional process responsible for atherosclerosis in coronary bifurcations?: an in vivo study based on dynamic CT and MRI.

    PubMed

    Ohayon, Jacques; Gharib, Ahmed M; Garcia, Alberto; Heroux, Julie; Yazdani, Saami K; Malvè, Mauro; Tracqui, Philippe; Martinez, Miguel-Angel; Doblare, Manuel; Finet, Gérard; Pettigrew, Roderic I

    2011-09-01

    Coronary bifurcations represent specific regions of the arterial tree that are susceptible to atherosclerotic lesions. While the effects of vessel compliance, curvature, pulsatile blood flow, and cardiac motion on coronary endothelial shear stress have been widely explored, the effects of myocardial contraction on arterial wall stress/strain (WS/S) and vessel stiffness distributions remain unclear. Local increase of vessel stiffness resulting from wall-strain stiffening phenomenon (a local process due to the nonlinear mechanical properties of the arterial wall) may be critical in the development of atherosclerotic lesions. Therefore, the aim of this study was to quantify WS/S and stiffness in coronary bifurcations and to investigate correlations with plaque sites. Anatomic coronary geometry and cardiac motion were generated based on both computed tomography and MRI examinations of eight patients with minimal coronary disease. Computational structural analyses using the finite element method were subsequently performed, and spatial luminal arterial wall stretch (LW(Stretch)) and stiffness (LW(Stiff)) distributions in the left main coronary bifurcations were calculated. Our results show that all plaque sites were concomitantly subject to high LW(Stretch) and high LW(Stiff), with mean amplitudes of 34.7 ± 1.6% and 442.4 ± 113.0 kPa, respectively. The mean LW(Stiff) amplitude was found slightly greater at the plaque sites on the left main coronary artery (mean value: 482.2 ± 88.1 kPa) compared with those computed on the left anterior descending and left circumflex coronary arteries (416.3 ± 61.5 and 428.7 ± 181.8 kPa, respectively). These findings suggest that local wall stiffness plays a role in the initiation of atherosclerotic lesions. PMID:21685261

  18. Myocardial fibrosis in desmin-related hypertrophic cardiomyopathy

    PubMed Central

    2010-01-01

    Desmin-related myopathy (DRM) is known to cause different types of cardiomyopathy. Late gadolinium enhancement cardiovascular magnetic resonance (CMR) has been shown to identify fibrosis in ischemic and non-ischemic cardiomyopathies. We present a rare case of desmin-related hypertrophic cardiomyopathy, CMR revealed fibrosis in the lateral wall of the left ventricle. CMR is superior to conventional echocardiography for the detection of myocardial fibrosis in desmin-related cardiomyopathy, which may be useful to detect early cardiac involvement and predict the patient prognosis. PMID:21083940

  19. Prediction of coronary plaque location on arteries having myocardial bridge, using finite element models.

    PubMed

    Nikolić, Dalibor; Radović, Miloš; Aleksandrić, Srđan; Tomašević, Miloje; Filipović, Nenad

    2014-11-01

    This study was performed to evaluate the influences of the myocardial bridges on the plaque initializations and progression in the coronary arteries. The wall structure is changed due to the plaque presence, which could be the reason for multiple heart malfunctions. Using simplified parametric finite element model (FE model) of the coronary artery having myocardial bridge and analyzing different mechanical parameters from blood circulation through the artery (wall shear stress, oscillatory shear index, residence time), we investigated the prediction of "the best" position for plaque progression. We chose six patients from the angiography records and used data from DICOM images to generate FE models with our software tools for FE preprocessing, solving and post-processing. We found a good correlation between real positions of the plaque and the ones that we predicted to develop at the proximal part of the myocardial bridges with wall shear stress, oscillatory shear index and residence time. This computer model could be additional predictive tool for everyday clinical examination of the patient with myocardial bridge. PMID:25139775

  20. Effect of coronary artery recanalization on right ventricular function in patients with acute myocardial infarction

    SciTech Connect

    Verani, M.S.; Tortoledo, F.E.; Batty, J.W.; Raizner, A.E.

    1985-05-01

    The effects of coronary artery recanalization by intracoronary administration of streptokinase on left ventricular function during acute myocardial infarction have received increasing attention in recent years. Although myocardial dysfunction is often more pronounced in the right ventricle than in the left ventricle in patients with acute inferior wall myocardial infarction, the effect of coronary artery recanalization on right ventricular dysfunction has not been previously addressed. Accordingly, in this investigation, 54 patients who participated in a prospective, controlled, randomized trial of recanalization during acute myocardial infarction were studied. Among 30 patients with inferior wall infarction, 19 had right ventricular dysfunction on admission; 11 of these 19 had positive uptake of technetium-99m pyrophosphate in the right ventricle, indicative of right ventricular infarction. Patients with successful recanalization exhibited improved right ventricular ejection fraction from admission to day 10. However, control patients and patients who did not undergo recanalization also exhibited improvement. These data indicate that the right ventricular dysfunction commonly associated with inferior wall infarction is often transient, and improvement is the rule, irrespective of early recanalization of the infarct vessel.

  1. Early pseudoaneurysm formation after the sutureless technique for left ventricular rupture due to acute myocardial infarction.

    PubMed

    Sasaki, Kenichi; Fukui, Toshihiro; Tabata, Minoru; Takanashi, Shuichiro

    2014-03-01

    Left ventricular free wall rupture is a fatal and catastrophic complication after acute myocardial infarction. The sutureless technique with a fibrin tissue-adhesive collagen fleece is reportedly safe and effective in the oozing type of left ventricular free wall rupture. However, late pseudoaneurysm formation after this technique has been reported. We herein report a 65-year-old male patient who presented with pseudoaneurysm formation 8 days after the sutureless technique for the oozing type of left ventricular free wall rupture. Successful repair of the pseudoaneurysm was subsequently performed. Pseudoaneurysm formation should be recognized even early after the sutureless technique. PMID:23529257

  2. Relationship Between MDCT‐Imaged Myocardial Fat and Ventricular Tachycardia Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy

    PubMed Central

    Komatsu, Yuki; Jadidi, Amir; Sacher, Frederic; Denis, Arnaud; Daly, Matthew; Derval, Nicolas; Shah, Ashok; Lehrmann, Heiko; Park, Chan‐Il; Weber, Reinhold; Arentz, Thomas; Pache, Gregor; Sermesant, Maxime; Ayache, Nicholas; Relan, Jatin; Montaudon, Michel; Laurent, François; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre; Cochet, Hubert

    2014-01-01

    Background Myocardial fibrofatty infiltration is a milieu for ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and can be depicted as myocardial hypodensity on contrast‐enhanced multidetector computed tomography (MDCT) with high spatial and temporal resolution. This study aimed to assess the relationship between MDCT‐imaged myocardial fat and VT substrate in ARVC. Methods and Results We studied 16 patients with ARVC who underwent ablation and preprocedural MDCT. High‐resolution imaging data were processed and registered to high‐density endocardial and epicardial maps in sinus rhythm on 3‐dimensional electroanatomic mapping (3D‐EAM) (626±335 and 575±279 points/map, respectively). Analysis of the locations of low‐voltage and fat segmentation included the following endocardial and epicardial regions: apex, mid (anterior, lateral, inferior), and basal (anterior, lateral, inferior). The location of local abnormal ventricular activities (LAVA) was compared with fat distribution. RV myocardial fat was successfully segmented and integrated with 3D‐EAM in all patients. The κ agreement test demonstrated a good concordance between the epicardial low voltage and fat (κ=0.69, 95% CI 0.54 to 0.84), but fair concordance with the endocardium (κ=0.41, 95% CI 0.27 to 0.56). The majority of LAVA (520/653 [80%]) were located within the RV fat segmentation, of which 90% were not farther than 20 mm from its border. Registration of MDCT allowed direct visualization of the coronary arteries, thus avoiding coronary damage during epicardial radiofrequency delivery. Conclusions The integration of MDCT‐imaged myocardial fat with 3D‐EAM provides valuable information on the extent and localization of VT substrate and demonstrates ablation targets clustering in its border region. PMID:25103203

  3. Thallium-201 myocardial scintigraphy in acute myocardial infarction and ischemia

    SciTech Connect

    Wackers, F.J.

    1982-04-01

    Thallium-201 scintigraphy provides a sensitive and reliable method of detecting acute myocardial infarction and ischemia when imaging is performed with understanding of the temporal characteristics and accuracy of the technique. The results of scintigraphy are related to the time interval between onset of symptoms and time of imaging. During the first 6 hr after chest pain almost all patients with acute myocardial infarction and approximately 50% of the patients with unstable angina will demonstrate /sup 201/TI pefusion defects. Delayed imaging at 2-4 hr will permit distinction between ischemia and infarction. In patients with acute myocardial infarction, the size of the perfusion defect accurately reflects the extent of the infarcted and/or jeopardized myocardium, which may be used for prognostic stratification. In view of the characteristics of /sup 201/TI scintigraphy, the most practical application of this technique is in patients in whom myocardial infarction has to be ruled out, and for early recognition of patients at high risk for complications.

  4. The anterior fibres of the levator ani muscle in man.

    PubMed Central

    Ayoub, S F

    1979-01-01

    The anatomy of the anterior portion of the levator ani muscle in studied in 26 adult human cadavers of both sexes. This portion of the muscle is found to consist of three layers of muscle fibres. The three layers are: 1. The pelvic layer. Its fibres (1) are attached to the capsule of the prostate or adventitia of the lateral wall of vagina, (2) intermingle with and supplement the longitudinal muscle layer of the anal canal, and (3) are continuous with the fibres of the opposite side behind the recto-anal junction. 2. The middle layer. The most anterior fibres are twisted on themselves to form the round free border of the muscle that bounds the levator hiatus. The majority of the muscle fibres of this layer proceed backwards to cover and blend with the deep part of the external anal shincter, partly joining the anococcygeal ligament. 3. The perineal layer. These fibres surround the superficial part of the external anal sphincter. A respectable bundle of muscles fibres unites with that of the opposite side in from of the lower part of the anal canal. Remaining fibres terminate in perianal skin or anococcygeal ligament. The role of the anterior portion of the levator ani in fixation and prevention of prolapse of the pelvic viscera is stressed. Images Fig. 1 Fig. 2 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 PMID:468708

  5. Selective Inhibition of the Master Regulator Transcription Factor Egr?1 With Catalytic Oligonucleotides Reduces Myocardial Injury and Improves Left Ventricular Systolic Function in a Preclinical Model of Myocardial Infarction

    PubMed Central

    Rayner, Benjamin S.; Figtree, Gemma A.; Sabaretnam, Tharani; Shang, Ping; Mazhar, Jawad; Weaver, James C.; Lay, William N.; Witting, Paul K.; Hunyor, Stephen N.; Grieve, Stuart M.; Khachigian, Levon M.; Bhindi, Ravinay

    2013-01-01

    Background Egr?1 is implicated in the pathogenesis of myocardial ischemiareperfusion injury. The aim of this study was to ascertain the effectiveness of intracoronary delivery of DNAzyme targeting the transcription factor Egr?1 at reperfusion following experimental myocardial ischemia. Methods and Results Functional DNAzyme targeting Egr?1 or a size?matched scrambled control were delivered via the intracoronary route immediately on reperfusion after 60 minutes' balloon occlusion of the left anterior descending coronary artery in a pig model of myocardial I/R injury (n=7 per treatment group). Heart function and extent of myocardial infarction were determined following intervention by echocardiography and cardiac magnetic resonance imaging, respectively. Hearts were removed and examined for molecular and histological markers of inflammation and apoptosis. Administration of functional DNAzyme led to an overall decrease in the expression of inflammatory markers including intracellular adhesion molecule?1, tissue factor, and complement 3, with associated decreases in the extent of neutrophil infiltration, oxidative damage, and subsequent apoptosis within the infarct border zone. Functional significance was indicated by an increase in salvaged left ventricular myocardium (P=0.012), ejection fraction (P=0.002), and fractional area change (P=0.039) in the functional DNAzymetreated group compared with the control. Conclusions Egr?1 silencing through intracoronary delivery of a targeting DNAzyme at the time of reperfusion following acute myocardial ischemia decreases myocardial inflammation and apoptosis leading to improved cardiac function. PMID:23902638

  6. Myocardial Infarction with Normal Coronary Arteries in a Patient with Heroin Use and Infective Endocarditis

    PubMed Central

    Chang, Kai-Wei; Yen, Yuan-Hung; Chan, Kuei-Chuan; Huang, Shao-Fan; Su, Chun-Hung

    2014-01-01

    Myocardial infarction with normal coronary arteries typically occurs in patients under 50 years of age. There is usually no history of angina or previous myocardial infarction, and risk factors for ischemic heart disease are frequently absent. We report a 27-year-old heroin user with normal coronary arteries and inferior wall infarction secondary to infective endocarditis. The left ventricular dysfunction normalized after antibiotic and surgical treatments for infective endocarditis. He was followed at our outpatient clinic for one year without recurrence. PMID:27122786

  7. Mechanisms of cell death in acute myocardial infarction: pathophysiological implications for treatment

    PubMed Central

    de Zwaan, C.; Daemen, M.J.A.P.; Hermens, W.Th.

    2001-01-01

    The purpose of this review is to draw attention to the growing list of pathophysiological phenomena occurring in blood, the vessel wall and cardiac tissue during myocardial infarction. A further aim is to point to the complexity of factors, contributing to cardiac dysfunction and the implications for therapy, aimed at limiting myocardial cell death. Not all pathophysiological mechanisms have been elucidated yet, indicating the necessity for further research in this area. In addition we describe interventions which have shown promise in animal studies, those which may show promise in humans, and those which are accepted as therapies of choice. PMID:25696691

  8. The allometric model in chronic myocardial infarction

    PubMed Central

    2012-01-01

    Background An allometric relationship between different electrocardiogram (ECG) parameters and infarcted ventricular mass was assessed in a myocardial infarction (MI) model in New Zealand rabbits. Methods A total of fifteen animals were used, out of which ten underwent left anterior descending coronary artery ligation to induce infarction (7–35% area). Myocardial infarction (MI) evolved and stabilized during a three month-period, after which, rabbits were sacrificed and the injured area was histologically confirmed. Right before sacrifice, ECGs were obtained to correlate several of its parameters to the infarcted mass. The latter was normalized after combining data from planimetry measurements and heart weight. The following ECG parameters were studied: RR and PR intervals, P-wave duration (PD), QRS duration (QRSD) and amplitude (QRSA), Q-wave (QA), R-wave (RA) and S-wave (SA) amplitudes, T-wave peak amplitude (TA), the interval from the peak to the end of the T-wave (TPE), ST-segment deviation (STA), QT interval (QT), corrected QT and JT intervals. Corrected QT was analyzed with different correction formulae, i.e., Bazett (QTB), Framingham (QTFRA), Fridericia (QTFRI), Hodge (QTHO) and Matsunaga (QTMA) and compared thereafter. The former variables and infarcted ventricular mass were then fitted to the allometric equation in terms of deviation from normality, in turn derived after ECGs in 5 healthy rabbits. Results Six variables (JT, QTB, QA, SA, TA and STA) presented statistical differences among leads. QT showed the best allometric fit (r = 0.78), followed by TA (r = 0.77), STA (r = 0.75), QTFRA (r = 0.72), TPE (r = 0.69), QTFRI (r = 0.68) and QTMA (r = 0.68). Corrected QT’s (QTFRA, QTFRI and QTMA) performed worse than the uncorrected counterpart (QT), the former scaling allometrically with similar goodness of fits. Conclusions QT, TA, STA and TPE could possibly be used to assess infarction extent in an old MI event through the allometric model as a first approach. Moreover, the TPE also produced a good allometric scaling, leading to the potential existence of promising allometric indexes to diagnose malignant arrhythmias. PMID:22578057

  9. Beam hardening artifact reduction using dual energy computed tomography: implications for myocardial perfusion studies

    PubMed Central

    Carrascosa, Patricia; Cipriano, Silvina; De Zan, Macarena; Deviggiano, Alejandro; Capunay, Carlos; Cury, Ricardo C.

    2015-01-01

    Background Myocardial computed tomography perfusion (CTP) using conventional single energy (SE) imaging is influenced by the presence of beam hardening artifacts (BHA), occasionally resembling perfusion defects and commonly observed at the left ventricular posterobasal wall (PB). We therefore sought to explore the ability of dual energy (DE) CTP to attenuate the presence of BHA. Methods Consecutive patients without history of coronary artery disease who were referred for computed tomography coronary angiography (CTCA) due to atypical chest pain and a normal stress-rest SPECT and had absence or mild coronary atherosclerosis constituted the study population. The study group was acquired using DE and the control group using SE imaging. Results Demographical characteristics were similar between groups, as well as the heart rate and the effective radiation dose. Myocardial signal density (SD) levels were evaluated in 280 basal segments among the DE group (140 PB segments for each energy level from 40 to 100 keV; and 140 reference segments), and in 40 basal segments (at the same locations) among the SE group. Among the DE group, myocardial SD levels and myocardial SD ratio evaluated at the reference segment were higher at low energy levels, with significantly lower SD levels at increasing energy levels. Myocardial signal-to-noise ratio was not significantly influenced by the energy level applied, although 70 keV was identified as the energy level with the best overall signal-to-noise ratio. Significant differences were identified between the PB segment and the reference segment among the lower energy levels, whereas at ≥70 keV myocardial SD levels were similar. Compared to DE reconstructions at the best energy level (70 keV), SE acquisitions showed no significant differences overall regarding myocardial SD levels among the reference segments. Conclusions BHA that influence the assessment of myocardial perfusion can be attenuated using DE at 70 keV or higher. PMID:25774354

  10. Detection of multivessel disease in patients with sustained myocardial infarction by thallium 201 myocardial scintigraphy: No additional value of quantitative analysis

    SciTech Connect

    Niemeyer, M.G.; Pauwels, E.K.; van der Wall, E.E.; Cramer, M.J.; Verzijlbergen, J.F.; Zwinderman, A.H.; Ascoop, C.A. )

    1989-01-01

    This study was performed to determine the value of visual and quantitative thallium 201 scintigraphy for the detection of multivessel disease in 67 patients with a sustained transmural myocardial infarction. Also the viability of the myocardial regions corresponding to pathologic Q-waves was evaluated. Of the 67 patients, 51 patients had multivessel coronary artery disease (76%). The sensitivity of the exercise test was 53%, of thallium scintigraphy 69%, when interpreted visually, and 67%, when analysed quantitatively. The specificity of these methods was 69%, 56%, and 50%, respectively. Sixty-two infarct-related flow regions were detected by visual analysis of the thallium scans, total redistribution was observed in 11/62 (18%) of patients, partial redistribution in 26/62 (42%), and no redistribution in 25/62 (40%) of patients. The infarct-related areas with total redistribution on the thallium scintigrams were more likely to be associated with normal or hypokinetic wall motion (7/11: 64%) than the areas with a persistent defect (7/25:28%) (P = 0.05), which were more related with akinetic or dyskinetic wall motion. Based on our results, it is concluded that (1) both visual and quantitative analysis of thallium exercise scintigraphy have limited value to predict the presence or absence of multivessel coronary artery disease in patients with sustained myocardial infarction, and (2) exercise-induced thallium redistribution may occur within the infarct zone, suggesting the presence of viable but jeopardized myocardium in presumed fibrotic myocardial areas.

  11. TachoSil for postinfarction ventricular free wall rupture.

    PubMed

    Pocar, Marco; Passolunghi, Davide; Bregasi, Alda; Donatelli, Francesco

    2012-06-01

    Despite a decline in the last three decades, postinfarction ventricular free wall rupture still complicates more than 3% of acute ST-elevation myocardial infarctions and remains a surgical challenge. TachoSil (Nycomed, Zurich, Switzerland) is an equine collagen patch coated with human fibrinogen and human thrombin, which has recently been used for haemostasis in cardiovascular surgery, but its potential usefulness in free wall rupture has not been reported. Initial clinical experience with an on-pump sutureless technique without cardioplegia, using wide TachoSil patching to achieve free wall rupture repair, has been described. PMID:22419793

  12. Simvastatin ameliorates ventricular remodeling via the TGF-β1 signaling pathway in rats following myocardial infarction

    PubMed Central

    XIAO, XIANGBIN; CHANG, GUANGLEI; LIU, JIAN; SUN, GUANGYUN; LIU, LI; QIN, SHU; ZHANG, DONGYING

    2016-01-01

    Statins are widely used in patients with cardiovascular diseases. A considerable number of previous studies revealed that the intracellular signaling of transforming growth factor (TGF)-β1 mediated the development of cardiomyocyte hypertrophy and interstitial fibrosis. However, whether statins can ameliorate ventricular remodeling in post-myocardial infarction via the TGF-β1 signaling pathway remains to be rigorously tested. The left anterior descending artery was ligated to induce a rat model of myocardial infarction. The rat model of myocardial infarction was treated with simvastatin through gastric gavage (10, 20 or 40 mg kg−1·d−1). All rats were sacrificed on day 28 after the myocardial infarction operation. The results revealed that simvastatin significantly improved the hemodynamic indexes, left ventricular mass index, the myocardial tissue structure, the cardiomyocyte cross-sectional area and the collagen volume fraction, and also showed that the levels of TGF-β1, TGF-activated kinase (TAK)1 and drosophila mothers against decapentaplegic (Smad)3 were significantly reduced following treatment with simvastatin, while the levels of Smad7 in the simvastatin treatment groups were markedly increased. The results of the present study suggested that statins ameliorated ventricular remodeling in post-myocardial infarction rats via the TGF-β1 signaling pathway, which provided a novel explanation for the pleiotropic effects of statins that benefit the cardiovascular system. PMID:27121011

  13. Simvastatin ameliorates ventricular remodeling via the TGF‑β1 signaling pathway in rats following myocardial infarction.

    PubMed

    Xiao, Xiangbin; Chang, Guanglei; Liu, Jian; Sun, Guangyun; Liu, Li; Qin, Shu; Zhang, Dongying

    2016-06-01

    Statins are widely used in patients with cardiovascular diseases. A considerable number of previous studies revealed that the intracellular signaling of transforming growth factor (TGF)‑β1 mediated the development of cardiomyocyte hypertrophy and interstitial fibrosis. However, whether statins can ameliorate ventricular remodeling in post‑myocardial infarction via the TGF‑β1 signaling pathway remains to be rigorously tested. The left anterior descending artery was ligated to induce a rat model of myocardial infarction. The rat model of myocardial infarction was treated with simvastatin through gastric gavage (10, 20 or 40 mg kg‑1·d‑1). All rats were sacrificed on day 28 after the myocardial infarction operation. The results revealed that simvastatin significantly improved the hemodynamic indexes, left ventricular mass index, the myocardial tissue structure, the cardiomyocyte cross‑sectional area and the collagen volume fraction, and also showed that the levels of TGF‑β1, TGF‑activated kinase (TAK)1 and drosophila mothers against decapentaplegic (Smad)3 were significantly reduced following treatment with simvastatin, while the levels of Smad7 in the simvastatin treatment groups were markedly increased. The results of the present study suggested that statins ameliorated ventricular remodeling in post‑myocardial infarction rats via the TGF‑β1 signaling pathway, which provided a novel explanation for the pleiotropic effects of statins that benefit the cardiovascular system. PMID:27121011

  14. Genomics and anterior segment dysgenesis: a review.

    PubMed

    Ito, Yoko A; Walter, Michael A

    2014-01-01

    Anterior segment dysgenesis refers to a spectrum of disorders affecting structures in the anterior segment of the eye including the iris, cornea and trabecular meshwork. Approximately 50% of patients with anterior segment dysgenesis develop glaucoma. Traditional genetic methods using linkage analysis and family-based studies have identified numerous disease-causing genes such as PAX6, FOXC1 and PITX2. Despite these advances, phenotypic and genotypic heterogeneity pose continuing challenges to understand the mechanisms underlying the complexity of anterior segment dysgenesis disorders. Genomic methods, such as genome-wide association studies, are potentially an effective tool to understand anterior segment dysgenesis and the individual susceptibility to the development of glaucoma. In this review, we provide the rationale, as well as the challenges, to utilizing genomic methods to examine anterior segment dysgenesis disorders. PMID:24433355

  15. Assessment of Myocardial Ischemia with Cardiovascular Magnetic Resonance

    PubMed Central

    Heydari, Bobak; Jerosch-Herold, Michael; Kwong, Raymond Y.

    2014-01-01

    Assessment of myocardial ischemia in symptomatic patients remains a common and challenging clinical situation faced by physicians. Risk stratification by presence of ischemia provides important utility for both prognostic assessment and management. Unfortunately, current noninvasive modalities possess numerous limitations and have limited prognostic capacity. More recently, ischemia assessment by cardiovascular magnetic resonance (CMR) has been shown to be a safe, available, and potentially cost-effective alternative with both high diagnostic and prognostic accuracy. Cardiovascular magnetic resonance has numerous advantages over other noninvasive methods, including high temporal and spatial resolution, relatively few contraindications, and absence of ionizing radiation. Furthermore, studies assessing the clinical utility and cost effectiveness of CMR in the short-term setting for patients without evidence of an acute myocardial infarction have also demonstrated favorable results. This review will cover techniques of ischemia assessment with CMR by both stress-induced wall motion abnormalities as well as myocardial perfusion imaging. The diagnostic and prognostic performance studies will also be reviewed, and the use of CMR for ischemia assessment will be compared with other commonly used noninvasive modalities. PMID:22014487

  16. Cardiac cryosurgery: effects of myocardial temperature on cryolesion size.

    PubMed

    Holman, W L; Ikeshita, M; Douglas, J M; Smith, P K; Cox, J L

    1983-02-01

    Cryothermic ablation of myocardium and portions of the specialized cardiac conduction tissue has been employed successfully for the treatment of both supraventricular and ventricular tachyarrhythmias. As more uses have been found for cardiac cryosurgery, increasing flexibility of the cryothermia system has been required. The present study was designed to develop a method for electively increasing or decreasing the dimensions and volume of cryolesions by altering adjacent myocardial temperatures. Fourteen dogs were subjected to cardiopulmonary bypass, and standard cryothermic exposures (4 mm cryoprobe, -60 degrees C for 120 seconds) were used to create cryolesions on the left ventricular free wall. The dimensions and volumes of cryolesions created at myocardial temperatures of 37 degrees, 32 degrees, and 6 degrees to 12 degrees C (hypothermic cardioplegic arrest) were compared. Cryolesions created at 6 degrees to 12 degrees C with the dogs under cardioplegic arrest were significantly larger (P less than 0.05) than cryolesions created t 37 degrees or 32 degrees C in the perfused beating heart. This information may be useful in improving the results of myocardial cryoablation, particularly in procedures requiring the ablation of large regions of myocardium or regions deep below the epicardial or endocardial surface. PMID:6823666

  17. Salmonella Urosepsis Complicated by Metastatic osteomyelitis of the Chest Wall.

    PubMed

    Vartian

    1997-09-01

    Although tens of thousands of Salmonella infections occur annually in this country, most involve the gastrointestinal tract with involvement of the urinary tract being quite infrequent.1-3 I would like to report a case of urosepsis due to Salmonella with eventual development of metastatic osteomyelitis of a rib that proved refractory to treatment. A 59-year-old Latin American male who resided in the Texas Rio Grande Valley presented to an emergency room with inability to void, having first noted a decreased urinary stream and dribbling a few months earlier. In-and-out bladder catheterization yielded 700 cc of urine, and he was sent out on co-trimoxazole one double-strength tablet twice daily. The patient returned within several hours, again unable to void, and a Foley catheter was inserted draining 1100 cc of urine. The patient was admitted for further evaluation. Past history was notable for long-standing inflammatory arthritis treated with injectable gold, hydroxychloroquine and nonsteroidal anti-inflammatory agents. He had previously undergone left shoulder replacement and synovectomy of both knees. Diabetes mellitus was diagnosed 6 years earlier and treated with oral hypoglycemic agents. The patient denied any gastrointestinal complaints. Examination was notable for a temperature of 102.4 degreesF and obvious sequelae of long-standing rheumatoid arthritis. The abdomen was entirely benign, but rectal examination revealed an enlarged, nontender prostate. White blood cell count was 11,200/mm3. Urinalysis revealed 10-12 white blood cells per high power field and 15-20 red blood cells per high power field. Two blood cultures from admission grew Salmonella species sensitive to all antibiotics. Urine cultured at the time of admission remained sterile. The patient was treated initially with tobramycin and ciprofloxacin and was changed to ceftriaxone 1 g intravenously every 12 hr when the Salmonella was identified. Ultrasound examination confirmed an enlarged prostate but disclosed no ureteral or renal abnormalities. Intravenous pyelogram also revealed the enlarged prostate but was otherwise unremarkable. On the ninth hospital day a transurethral resection of the prostate (TURP) was performed with histologic evidence of abscesses containing acute inflammatory cells in the resected tissue. The tissue itself was culture negative. He gradually defervesced and completed a 14-day course of parenteral therapy. The patient did well for about 6 months at which point he developed anterior chest wall pain for which he applied a heating pad. A second degree burn developed which ulcerated and began to drain. Culture revealed Salmonella species with a similar sensitivity pattern as the previous isolate. Local care as well as courses of oral ciprofloxacin and chloramphenicol failed to eradicate the drainage. The patient underwent surgical excision of the sinus tract 11 months after the initial bacteremia. Surgical specimens again grew Salmonella. Unfortunately, neither this nor the previous chest wall isolate was saved for further analysis. The area continued to drain and bone scan was consistent with osteomyelitis of the left sixth rib. Ceftriaxone 2 g intravenously per day was begun. The following month (16 months after the initial bacteremia) the patient underwent extensive debridement of the anterior chest wall with removal of the sixth and seventh ribs, and closure via a pectoralis myocutaneous flap. Forty-eight hours postoperatively, the patient suffered an acute myocardial infarction and expired. Postmortem revealed severe coronary artery disease. No additional focus of Salmonella infection was found. PMID:9815503

  18. Myocardial contusion following nonfatal blunt chest trauma

    SciTech Connect

    Kumar, S.A.; Puri, V.K.; Mittal, V.K.; Cortez, J.

    1983-04-01

    Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma.

  19. Concomitant anterior and posterior infantile perianal protrusions.

    PubMed

    Leung, Alexander K C

    2010-02-01

    Infantile perianal protrusion is characterized by asymptomatic pyramidal protrusion with a rose-red or purplish red surface along the midline, usually anterior to the anus. The protrusion is usually solitary. Two girls are reported with concomitant anterior and posterior infantile perianal pyramidal protrusions and a history of constipation. The occurrence of concomitant anterior and posterior infantile perianal pyramidal protrusions has not been reported previously. PMID:20191927

  20. Cooling wall

    SciTech Connect

    Nosenko, V.I.

    1995-07-01

    Protecting the shells of blast furnaces is being resolved by installing cast iron cooling plates. The cooling plates become non-operational in three to five years. The problem is that defects occur in manufacturing the cooling plates. With increased volume and intensity of work placed on blast furnaces, heat on the cast iron cooling plates reduces their reliability that limits the interim repair period of blast furnaces. Scientists and engineers from the Ukraine studied this problem for several years, developing a new method of cooling the blast furnace shaft called the cooling wall. Traditional cast iron plates were replaced by a screen of steel tubes, with the area between the tubes filled with fireproof concrete. Before placing the newly developed furnace shaft into operation, considerable work was completed such as theoretical calculations, design, research of temperature fields and tension. Continual testing over many years confirms the value of this research in operating blast furnaces. The cooling wall works with water cooling as well as vapor cooling and is operating in 14 blast furnaces in the Ukraine and two in Russia, and has operated for as long as 14 years.

  1. Myocardial remodeling and pathologic hypertrophy.

    PubMed

    Weber, K T; Brilla, C G; Janicki, J S

    1991-04-15

    The hallmark of myocardial hypertrophy associated with congestive failure is interstitial fibrosis. How does the fibrosis develop, and what can be done about it? Hormonal and hemodynamic factors are examined. Experimental studies with ACE inhibitors or aldosterone receptor antagonists suggest that the fibrosis may be prevented or reversed. PMID:2010482

  2. Spousal Adjustment to Myocardial Infarction.

    ERIC Educational Resources Information Center

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  3. Myocardial blood flow during induced aortic hypertension in dogs

    SciTech Connect

    Thai, B.N.; Levesque, M.J.; Nerem, R.M.

    1986-03-01

    Myocardial blood flow was measured in anesthetized dogs during control conditions and under conditions where the aortic pressure was increased due to aortic constriction or during infusion. Blood flow was measured using the radioactive microsphere technique. Radioactive microspheres (15 m Ce-141, Sr-85, and Sc-46) were injected under control, aortic constriction and arterenol infusion in four dogs and under control conditions in two others. All microsphere injections were performed under stabilized conditions. It was found that coronary blood flow rose by 80% during aortic constriction and by 158% during arterenol infusion (P < 0.05). This increase in blood flow was not uniform throughout the heart, and higher increases were observed in the middle and apex regions of the left ventricle. Furthermore, under hypertension the increase in blood flow in LAD (left anterior descending) perfused territories was slightly higher than that in CFX (left circumflex) perfused territories.

  4. Bone metastasis on Tc99-m sestamibi myocardial perfusion scan

    PubMed Central

    Hatemi, Lachin; Jabi, Feraas

    2015-01-01

    A 75-year-old woman presented to our department for a stress myocardial perfusion imaging study with Tc99m-sestamibi. Incidental focal uptake, found in the left upper anterior chest, was initially felt to be located in the left breast. After additional single-photon CT imaging was performed the same day, extracardiac foci within the ribs, spine, and left lung (worrisome for active metastases) were shown to be present, with the initial focus located within a left rib rather than a breast. A review of previous radiographic and nuclear imaging studies confirmed metastatic disease from recurrent follicular thyroid cancer. Atypical focal extracardiac activity must be closely scrutinized for the possibility of malignancy, as Tc99m-sestamibi (in addition to being myocardium-avid) is tumor-avid.

  5. Wellens' syndrome: a classical electrocardiographic sign of impending myocardial infarction.

    PubMed

    Singh, Bhupinder; Singh, Yadvinder; Singla, Vivek; Nanjappa, Manjunath C

    2013-01-01

    We describe a case of previously healthy 72-year-old man, who presented with rest angina. The ECG revealed sinus rhythm, biphasic T waves with preserved R waves in V1-V4 precordial leads. Subsequent evaluation revealed the normal serum cardiac marker levels and echocardiography with the coronary angiography showing a critical lesion in the proximal left anterior descending artery. Thus it was diagnosed as Wellens' syndrome. In our case, we highlight the subtle though classical ECG findings of Wellens' syndrome and its specific angiographic correlation. It can be of vital importance to identify these changes and intervene in time appropriately so as to avoid the development of myocardial infarction that carries a substantial morbidity and mortality. Important aspects of diagnosis and management have also been reviewed. PMID:23420731

  6. Regional myocardial extraction of a radioiodinated branched chain fatty acid during right ventricular pressure overload due to acute pulmonary hypertension

    SciTech Connect

    Hurford, W.; Lowenstein, E.; Zapol, W.; Barlai-Kovach, M.; Livni, E.; Elmaleh, D.R.; Strauss, H.W.

    1985-05-01

    To determine whether branched chain fatty acid extraction is reduced during right ventricular (RV) dysfunction due to acute pulmonary artery hypertension, studies were done in 6 anesthetized dogs. Regional branched chain fatty acid extraction was measured by comparing the myocardial uptake of I-125 labeled 15-(p-(iodophenyl))-3-methylpentadecanoic acid (I-PDA) to myocardial blood flow. Acute pulmonary hypertension was induced by incremental intravenous injection of 100 micron diameter glass beads into six pentobarbital anesthetized, mechanically ventilated dogs. Myocardial blood flow was measured by radiolabeled microspheres both under baseline conditions and during pulmonary hypertension. Mean RV pressure rose from 12 +- 2 (mean +- SEM) to 30 +-3mmHg resulting in a 225 +- 16% increase in RV stroke work. RV ejection fraction, as assessed by gated blood pool scans fell from 39 +- 2 to 18 +- 2%. Left ventricular (LV) pressures, stroke work and ejection fraction were unchanged. Myocardial blood flow increased 132 + 59% in the RV free wall and 67 +- 22% in the RV septum. LV blood flow was unchanged. Despite increased RV work and myocardial blood flow, no differences were noted in the branched chain fatty acid extraction ratios among LV or RV free walls or septum. The authors conclude that early RV dysfunction associated with pulmonary artery hypertension is not due to inadequate myocardial blood flow or branched chain fatty acid extraction.

  7. Biomarkers in acute myocardial infarction

    PubMed Central

    2010-01-01

    Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. This may facilitate tailoring of appropriate therapy to high-risk patients. This review focuses on a variety of promising biomarkers which provide diagnostic and prognostic information. Heart-type Fatty Acid Binding Protein and copeptin in combination with cardiac troponin help diagnose myocardial infarction or acute coronary syndrome in the early hours following symptoms. An elevated N-Terminal Pro-B-type Natriuretic Peptide has been well validated to predict death and heart failure following a myocardial infarction. Similarly other biomarkers such as Mid-regional pro-Atrial Natriuretic Peptide, ST2, C-Terminal pro-endothelin 1, Mid-regional pro-Adrenomedullin and copeptin all provide incremental information in predicting death and heart failure. Growth differentiation factor-15 and high-sensitivity C-reactive protein predict death following an acute coronary syndrome. Pregnancy associated plasma protein A levels following chest pain predicts risk of myocardial infarction and revascularisation. Some biomarkers such as myeloperoxidase and high-sensitivity C-reactive protein in an apparently healthy population predicts risk of coronary disease and allows clinicians to initiate early preventative treatment. In addition to biomarkers, various well-validated scoring systems based on clinical characteristics are available to help clinicians predict mortality risk, such as the Thrombolysis In Myocardial Infarction score and Global Registry of Acute Coronary Events score. A multimarker approach incorporating biomarkers and clinical scores will increase the prognostic accuracy. However, it is important to note that only troponin has been used to direct therapeutic intervention and none of the new prognostic biomarkers have been tested and proven to alter outcome of therapeutic intervention. Novel biomarkers have improved prediction of outcome in acute myocardial infarction, but none have been demonstrated to alter the outcome of a particular therapy or management strategy. Randomised trials are urgently needed to address this translational gap before the use of novel biomarkers becomes common practice to facilitate tailored treatment following an acute coronary event. PMID:20529285

  8. Myocardial disarray. A critical review.

    PubMed Central

    Becker, A E; Caruso, G

    1982-01-01

    Myocardial disarray or disorganisation is at present a contentious topic, not least because its value as a clinical marker for hypertrophic cardiomyopathy has changed considerably over the years. Initially observed as one of the features of asymmetric septal hypertrophy, disarray has since been promoted as its pathognomonic histological feature, regarded by some observers as the morphological manifestation of a genetically transmitted myocardial defect. Recently, however, it has become evident that myocardial disarray is not limited to hypertrophic cardiomyopathy, but is encountered in hearts with both congenital and acquired conditions, and is also observed in normal hearts. The specificity of disarray for hypertrophic cardiomyopathy is thus seriously questioned. Latterly, it has been suggested that disarray, judged from through-and-through sections of the ventricular midseptum is a highly specific and sensitive marker of hypertrophic cardiomyopathy when considered in quantitative rather than qualitative fashion. The present study sets out to answer the question whether disarray could be the histological expression of the normal but intricate fibre architecture of the heart, a consideration also initiated by debatable definitions of normality and abnormality of myocardial histology. Gross fibre dissections in five normal hearts showed that many sites occurred in which disarray was a natural phenomenon. In five more hearts it was found that the plane of section of a tissue block might profoundly influence the histology. In fact, tissue cubicles sampled from different faces showed a change in histology in the vast majority. Thus the diagnostic significance of myocardial disarray as a marker of hypertrophic cardiomyopathy in the clinical setting almost vanishes; a change in orientation of a tissue section may actually turn "normality" into "disarray". Images PMID:7044398

  9. Electrocardiograms Corresponding to the Development of Myocardial Infarction in Anesthetized WHHLMI Rabbits (Oryctolagus cuniculus), an Animal Model for Familial Hypercholesterolemia

    PubMed Central

    Kobayashi, Tsutomu; Ito, Takashi; Yamada, Satoshi; Kuniyoshi, Nobue; Shiomi, Masashi

    2012-01-01

    The aim of this study was to determine whether features indicative of myocardial ischemia occur in the electrocardiograms (ECG) in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits, an animal model for human familial hypercholesterolemia. ECG were recorded in 110 anesthetized WHHLMI rabbits (age, 10 to 39 mo) by using unipolar and bipolar limb leads with or without chest leads. We noted the following electrocardiographic changes: T wave inversion (37.4%), ST segment depression (31.8%), deep Q wave (16.3%), reduced R wave amplitude (7.3%), ST segment elevation (2.7%), and high T wave (1.8%). These ECG changes resembled those in human patients with coronary heart disease. Histopathologic examination revealed that the left ventricular wall showed acute myocardial lesions, including loss of cross-striations, vacuolar degeneration, coagulation necrosis of cardiac myocytes, and edema between myofibrils, in addition to chronic myocardial lesions such as myocardial fibrosis. The coronary arteries that caused these ECG changes were severely stenosed due to atherosclerotic lesions. Ischemic ECG changes corresponded to the locations of the myocardial lesions. Normal ECG waveforms were similar between WHHLMI rabbits and humans, in contrast to the large differences between rabbits and mice or rats. In conclusion, ischemic ECG changes in WHHLMI rabbits reflect the location of myocardial lesions, making this model useful for studying coronary heart disease. PMID:23114045

  10. [Acute myocardial infarction in the postoperative period following pneumonectomy].

    PubMed

    López Alvarez, S; Bonome González, C; Izquierdo Villarroya, B; Barbeito Vilariño, M J; Etxainz Alvarez, A; Alvarez Refojo, F

    2002-11-01

    A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided. PMID:12516493

  11. Thallium-201 myocardial imaging in young adults with anomalous left coronary artery arising from the pulmonary artery

    SciTech Connect

    Moodie, D.S.; Cook, S.A.; Gill, C.C.; Napoli, C.A.

    1980-11-01

    Anomalous origin of the left coronary artery from the pulmonary artery (Bland-Garland-White syndrome) may produce myocardial ischemia, infarction, and frequently death in infancy. Some patients, however, develop satisfactory coronary artery collaterals and are relatively asymptomatic into adulthood. Very little is known about their myocardial perfusion patterns. We studied three young adults with this condition using stress thallium-201 myocardial imaging. Electrocardiograms in two patients demonstrated old arterolateral myocardial infarctions. Preoperative stress exercise tests were positive in all three patients. Marked perfusion abnormalities were found in the proximal anterolateral wall in all patients, and one patient also had a posterolateral defect. Postoperatively, all stress tests returned to normal. Thallium imaging demonstrated improvement in ischemic areas, but old scars persisted.

  12. Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

    NASA Astrophysics Data System (ADS)

    Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

    2008-09-01

    This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

  13. Multimodality Imaging in the Assessment of the Physiological Significance of Myocardial Bridging.

    PubMed

    Uusitalo, Valtteri; Saraste, Antti; Knuuti, Juhani

    2016-01-01

    In myocardial bridging (MB) a segment of the coronary artery is covered by the myocardium. MB can be seen as a systolic compression by invasive coronary angiography (ICA) or as an intramural course by computed tomography angiography (CTA). Intramural course is a common incidental finding in CTA studies. Only minority of the bridging segments are associated with systolic compression causing a possible impairment of myocardial perfusion. The relationship between myocardial blood flow and MB is complex and poorly evaluated by anatomic imaging. Furthermore, provocation tests are frequently needed to uncover systolic compression. Fractional flow reserve can be used to assess the hemodynamic significance of MB. Nuclear perfusion imaging can demonstrate flow abnormalities associated with MB. Stress echocardiography can demonstrate ischemic wall motion abnormalities. They can be complemented by hybrid imaging with CTA to distinguish epicardial coronary artery disease and MB. This article will review different imaging modalities for the evaluation of the physiologic significance of MB. PMID:26694724

  14. A case of spontaneous myocardial necrosis and cerebral ischemic lesions in a laboratory beagle dog

    PubMed Central

    Matsushita, Kohei; Kohara, Yukari; Ito, Yuko; Yoshikawa, Tsuyoshi; Sato, Makoto; Kitaura, Keisuke; Matsumoto, Satoshi

    2015-01-01

    A beagle dog treated with saline as a control animal in a preclinical study was euthanized due to sudden systemic deterioration. On histopathological examination, contraction band necrosis of myocardial cells was observed widely in the left ventricular wall, including the papillary muscle and apex, and observed slightly in the ventricular septum and left atrium. In the brain, necrosis was observed in neurons and glia of the cerebral cortex, hippocampal pyramidal cells, glial cells of the rostral commissure and Purkinje cells of the cerebellar vermis. It is highly probable that the marked systemic deterioration was caused by cardiac dysfunction due to the spontaneous contraction band necrosis of the myocardial cells, although the pathogenesis of the myocardial lesions remains unclear. Given the distribution of neuronal necrosis in the brain, it is likely that these lesions resulted from the ischemia responsible for acute cardiac failure. PMID:26538814

  15. Early detection of acute transmural myocardial ischemia by the phasic systolic-diastolic changes of local tissue electrical impedance.

    PubMed

    Jorge, Esther; Amorós-Figueras, Gerard; García-Sánchez, Tomás; Bragós, Ramón; Rosell-Ferrer, Javier; Cinca, Juan

    2016-02-01

    Myocardial electrical impedance is influenced by the mechanical activity of the heart. Therefore, the ischemia-induced mechanical dysfunction may cause specific changes in the systolic-diastolic pattern of myocardial impedance, but this is not known. This study aimed to analyze the phasic changes of myocardial resistivity in normal and ischemic conditions. Myocardial resistivity was measured continuously during the cardiac cycle using 26 different simultaneous excitation frequencies (1 kHz-1 MHz) in 7 anesthetized open-chest pigs. Animals were submitted to 30 min regional ischemia by acute left anterior descending coronary artery occlusion. The electrocardiogram, left ventricular (LV) pressure, LV dP/dt, and aortic blood flow were recorded simultaneously. Baseline myocardial resistivity depicted a phasic pattern during the cardiac cycle with higher values at the preejection period (4.19 ± 1.09% increase above the mean, P < 0.001) and lower values during relaxation phase (5.01 ± 0.85% below the mean, P < 0.001). Acute coronary occlusion induced two effects on the phasic resistivity curve: 1) a prompt (5 min ischemia) holosystolic resistivity rise leading to a bell-shaped waveform and to a reduction of the area under the LV pressure-impedance curve (1,427 ± 335 vs. 757 ± 266 Ω·cm·mmHg, P < 0.01, 41 kHz) and 2) a subsequent (5-10 min ischemia) progressive mean resistivity rise (325 ± 23 vs. 438 ± 37 Ω·cm at 30 min, P < 0.01, 1 kHz). The structural and mechanical myocardial dysfunction induced by acute coronary occlusion can be recognized by specific changes in the systolic-diastolic myocardial resistivity curve. Therefore these changes may become a new indicator (surrogate) of evolving acute myocardial ischemia. PMID:26608340

  16. Protective effects of p-nitro caffeic acid phenethyl ester on acute myocardial ischemia-reperfusion injury in rats

    PubMed Central

    DU, QIN; HAO, CHUNZHI; GOU, JING; LI, XIAOLI; ZOU, KAILI; HE, XIAOYAN; LI, ZHUBO

    2016-01-01

    Myocardial ischemia-reperfusion (IR) causes widespread cardiomyocyte dysfunction, including apoptosis and necrosis. The present study aimed to investigate the possible cardioprotective effects of p-nitro caffeic acid phenethyl ester (CAPE-NO2) on myocardial IR-induced injury in vivo. To generate a rat model of myocardial IR, the left anterior descending coronary artery was occluded for 30 min, followed by reperfusion for 2 h. The rats were administered either the sham treatment (the sham and IR control groups) or the therapeutic agents [the caffeic acid phenethyl ester (CAPE) and CAPE-NO2 groups] 10 min prior to the occlusion. Myocardial IR-induced injury is characterized by: A significant increase in the levels of myocardial enzymes, including creatine kinase, lactate dehydrogenase and aspartate transaminase; a marked increase in intercellular adhesion molecule 1 expression levels, lipid peroxidation products and inflammatory mediators; and a significant decrease in myocardial antioxidants, including catalase, total superoxide dismutase and glutathione peroxidase. In the present study, pretreatment with CAPE-NO2 significantly ameliorated these changes, and decreased the infarct size, as compared with the IR control group (10.32±3.8 vs. 35.65±5.4%). Furthermore, western blotting demonstrated that pretreatment with CAPE-NO2 downregulated the myocardial IR-induced protein expression levels of B-cell lymphoma-2 (Bcl-2)-associated X protein (Bax), cleaved caspase-3, P38 and the Bax/Bcl-2 ratio. CAPE-NO2 also upregulated the myocardial IR-induced expression levels of Bcl-2, phosphoinositide-3-kinase, phosphorylated Akt and mammalian target of rapamycin. In conclusion, the results of the present study indicated that CAPE-NO2 demonstrated improved cardioprotective effects, as compared with CAPE; therefore, CAPE-NO2 may represent a novel approach to pharmacological cardioprotection. PMID:27073461

  17. The effect of levosimendan on myocardial ischemia–reperfusion injury in streptozotocin-induced diabetic rats

    PubMed Central

    Kiraz, Hasan Ali; Poyraz, Fatih; Kip, Gülay; Erdem, Özlem; Alkan, Metin; Arslan, Mustafa; Özer, Abdullah; Şivgin, Volkan; Çomu, Faruk Metin

    2015-01-01

    Objective Ischemia/reperfusion (I/R) injury is an important cause of myocardial damage by means of oxidative, inflammatory, and apoptotic mechanisms. The aim of the present study was to examine the potential cardio protective effects of levosimendan in a diabetic rat model of myocardial I/R injury. Methods A total of 18 streptozotocin-induced diabetic Wistar Albino rats (55 mg/kg) were randomly divided into three equal groups as follows: the diabetic I/R group (DIR) in which myocardial I/R was induced following left thoracotomy, by ligating the left anterior descending coronary artery for 60 min, followed by 2 h of reperfusion; the diabetic I/R levosimendan group (DIRL), which underwent I/R by the same method while taking levosimendan intraperitoneal 12 µg kg−1; and the diabetic control group (DC) which underwent sham operations without tightening of the coronary sutures. As a control group (C), six healthy age-matched Wistar Albino rats underwent sham operations similar to the DC group. Two hours after the operation, the rats were sacrificed and the myocardial tissue samples were examined by light microscopy for evidence of myonecrosis and inflammatory cell infiltration. Results Myonecrosis findings were significantly different among groups (p=0.008). Myonecrosis was more pronounced in the DIR group compared with the C, DC, and DIRL groups (p=0.001, p=0.007 and p=0.037, respectively). Similarly, the degree of inflammatory cell infiltration showed significant difference among groups (p<0.0001). Compared with C, DC, and DIRL groups, the inflammatory cell infiltration was significantly higher among the DIR group (p<0.0001, p<0.0001, and p=0.020, respectively). Also, myocardial tissue edema was significantly different among groups (p=0.006). The light microscopic myocardial tissue edema levels were significantly higher in the DIR group than the C, DC, and DIRL groups (p=0.001, p=0.037, and p=0.014, respectively). Conclusion Taken together, our data indicate that levosimendan may be helpful in reducing myocardial necrosis, myocardial inflammation, and myocardial tissue edema resulting from ischemia–reperfusion injury. PMID:26649830

  18. Is coronary artery bypass grafting an acceptable alternative to myotomy for the treatment of myocardial bridging?

    PubMed

    Attaran, Saina; Moscarelli, Marco; Athanasiou, Thanos; Anderson, Jon

    2013-03-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Is CABG an effective alternative for the treatment of myocardial bridging?' Altogether, only six papers were identified using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated; these studies reported the outcome of myotomy and coronary artery bypass grafting (CABG) for myocardial bridging. All of these studies were retrospective reports of the results of surgical intervention in patients with myocardial bridging. They showed that the incidence of myocardial bridging was less than 1-1.5% in patients with angina requiring angiography, and 7-9% of these patients had refractory angina despite medical treatment and required surgery. The evidence on the treatment of this congenital condition that mainly affects the middle segment of left anterior descending artery is limited, and there are no treatment guidelines currently available. Stenting of the tunnelled segment has shown high failure rates in approximately half of the cases. Current evidence in the literature suggests that surgery is the mainstay treatment for myocardial bridging. Surgery is performed either as supra-arterial myotomy and de-roofing of the muscle bands on- or off-pump, or as coronary artery bypass grafting of the affected coronary artery beyond the tunnelled segment. Although no mortality was reported with either of these operations, surgical myotomy on deep and extensive myocardial bridges carries the risk of entering the right ventricle, bleeding and aneurysm formation. In addition, in a small percentage of the patients undergoing myotomy, angina recurred. Despite the possibility of competitive flow in the native coronary artery after CABG for myocardial bridging, we did not identify any evidence demonstrating graft occlusion after CABG for myocardial bridging. In conclusion, in extensive and deep myocardial bridgings, CABG may be the treatment of choice that carries low risk, limited complications and excellent symptomatic relief. PMID:23171516

  19. Baicalein, a Component of Scutellaria baicalensis, Attenuates Kidney Injury Induced by Myocardial Ischemia and Reperfusion.

    PubMed

    Lai, Chang-Chi; Huang, Po-Hsung; Yang, An-Han; Chiang, Shu-Chiung; Tang, Chia-Yu; Tseng, Kuo-Wei; Huang, Cheng-Hsiung

    2016-02-01

    Acute kidney injury is a common and severe complication of acute myocardial infarction and cardiac surgery. It results in increased mortality, morbidity, and duration of hospitalization. Baicalein is a component of the root of Scutellaria baicalensis, which has traditionally been used to treat cardiovascular and liver diseases in Asia. In this study, we investigated whether baicalein can attenuate kidney injury induced by myocardial ischemia and reperfusion in rats. Myocardial ischemia and reperfusion, induced by a 40-minute occlusion and a 3-hour reperfusion of the left anterior descending coronary artery, significantly increased blood urea nitrogen and creatinine levels in addition to causing histological changes in the kidneys. Kidney apoptosis was also significantly increased. Furthermore, myocardial ischemia and reperfusion significantly increased the serum levels of tumor necrosis factor-α, interleukin-1, and interleukin-6 as well as the tumor necrosis factor-α levels in the kidneys. Intravenous pretreatment with baicalein (in doses of 3, 10, or 30 mg/kg), however, significantly reduced the increases in the creatinine level, renal histological damage, and apoptosis induced by myocardial ischemia and reperfusion. In addition, the increases in the serum levels of tumor necrosis factor-α, interleukin-1, and interleukin-6, and of tumor necrosis factor-α in the kidneys were significantly reduced. Western blot analysis revealed that baicalein significantly increased Bcl-2 and reduced Bax in the kidneys. The phosphorylation of Akt and extracellular signal-regulated kinases 1 and 2 was also significantly increased. In conclusion, baicalein significantly attenuates kidney injury induced by myocardial ischemia and reperfusion. The underlying mechanisms might be related to the inhibition of apoptosis, possibly through the reduction of tumor necrosis factor-α production, the modulation of Bcl-2 and Bax, and the activation of Akt and extracellular signal-regulated kinases 1 and 2. PMID:26550790

  20. Direct Evaluation of Myocardial Viability and Stem Cell Engraftment Demonstrates Salvage of the Injured Myocardium

    PubMed Central

    Kim, Paul J.; Mahmoudi, Morteza; Ge, Xiaohu; Matsuura, Yuka; Toma, Ildiko; Metzler, Scott; Kooreman, Nigel G.; Ramunas, John; Holbrook, Colin; McConnell, Michael V.; Blau, Helen; Harnish, Phillip; Rulifson, Eric; Yang, Phillip C.

    2015-01-01

    Rationale The mechanism of functional restoration by stem cell therapy remains poorly understood. Novel manganese-enhanced MRI and bioluminescence reporter gene imaging (BLI) were applied to follow myocardial viability and cell engraftment, respectively. Human-placenta-derived amniotic mesenchymal stem cells (AMCs) demonstrate unique immunoregulatory and pre-cardiac properties. In this study, the restorative effects of three AMC-derived sub-populations were examined in a murine myocardial injury model: 1) unselected AMCs (uAMCs), 2) ckit+AMCs (c+AMCs), and 3) AMC-derived iPSCs (MiPSCs). Objective Determine the differential restorative effects of the AMC-derived sub-populations in the murine myocardial injury model using multi-modality imaging. Methods and Results SCID mice underwent left anterior descending artery ligation and were divided into 4 treatment arms: 1) normal saline control (n=14), 2) uAMCs (n=10), 3) c+AMCs (n=13), and 4) MiPSCs (n=11). Cardiac MRI assessed myocardial viability and left ventricular (LV) function while BLI assessed stem cell engraftment over a four-week period. Immunohistological labeling and RT-PCR of the explanted myocardium were performed. The uAMC and c+AMC treated mice demonstrated transient LV functional improvement. However, the MiPSCs exhibited a significantly greater increase in LV function compared to all the other groups during the entire four-week period. LV functional improvement correlated with increased myocardial viability and sustained stem cell engraftment. The MiPSCs treated animals lacked any evidence of de novo cardiac differentiation. Conclusion The functional restoration seen in MiPSCs was characterized by increased myocardial viability and sustained engraftment without de novo cardiac differentiation, indicating salvage of the injured myocardium. PMID:25654979

  1. Diazoxide Amelioration of Myocardial Injury and Mitochondrial Damage During Cardiac Surgery

    PubMed Central

    McCully, James D.; Wakiyama, Hidetaka; Cowan, Douglas B.; Federman, Micheline; Parker, Robert A.; Levitsky, Sidney

    2013-01-01

    Background Recently, we have shown that the selective opening of mitochondrial ATP-sensitive potassium channels with diazoxide significantly decreases myocardial injury. The purpose of this study was to determine the effects of diazoxide on apoptosis and the mechanisms modulating apoptosis and myocardial injury in a blood-perfused model of acute myocardial infarction. Methods Pigs (32 to 42 kg) undergoing total cardiopulmonary bypass underwent left anterior descending coronary artery occlusion for 30 minutes. The aorta was cross-clamped and magnesium-supplemented potassium cold-blood cardioplegia (DSA; n = 6) or magnesium-supplemented potassium cardioplegia containing 50 μmol/L diazoxide (DZX; n = 6) was administered, followed by 30 minutes of global ischemia and 120 minutes of reperfusion. Left ventricular tissue samples from DSA and DZX hearts were obtained after reperfusion. Apoptosis was determined by TUNEL, caspase-3 and PARP cleavage, and caspase-3 activity. Bax and bcl-2 levels were determined and tissue morphology was examined by light and transmission electron microscopy. Results Apoptosis, as estimated by TUNEL-positive nuclei/3,000 myocardial cells, was 120.3 ± 48.8 in DSA hearts and was significantly decreased to 21.4 ± 5.3 in DZX hearts (p < 0.05 vs control). Caspase-3 and poly-ADP-ribose polymerase cleavage and pro-apoptotic bax protein levels were significantly decreased with diazoxide (p < 0.05 vs DSA). Light and transmission electron microscopy indicated severe disruption of tissue with capillary dilatation, mitochondrial cristae damage, and evidence of increased presence of mitochondrial granules in DSA as compared with DZX hearts. Conclusions The addition of diazoxide (50 μmol/L) to cardioplegia significantly decreases regional myocardial apoptosis and mitochondrial damage, and provides an additional modality for achieving myocardial protection. PMID:12643408

  2. Recurrent anterior uveitis induced by multiple systemic injections of muramyl dipeptide.

    PubMed

    Li, T; Fox, K; Fox, A; Pakalnis, V

    1993-07-01

    The development of new therapeutic modalities in the treatment of uveitis has been greatly aided by the availability of suitable animal models. The endotoxin model excellently mimics many features of acute anterior uveitis. A new model that exhibits many features of recurrent anterior uveitis is described here. Muramyl dipeptide, MDP, is a synthetic monomer of Gram positive and Gram negative bacterial cell walls. The molecule is highly inflammatory, but unlike endotoxin does not elicit an antibody response. After a single injection (4 hr post-injection), acute anterior segment changes include massive engorgement of peri-limbal blood vessels, anterior chamber flare, fibrin deposits and heterophil (neutrophil) infiltration which subside within 24-48 hr. There is also break-down of the blood-aqueous barrier. With multiple injections the exacerbations and remissions continue to be observed after each injection but the disease progresses to a recurrent form including the development of synechiae and a mononuclear infiltrate into the anterior segment. The ocular changes are paralleled by changes in the bloodstream with recurrent heterophilia. Thus MDP does not elicit ocular or systemic tolerance. This new model of anterior uveitis should allow study of many of the events that occur in recurrent uveitis in man. PMID:8405175

  3. The morphology, innervation and neural control of the anterior arterial system of Aplysia californica.

    PubMed

    Skelton, M E; Koester, J

    1992-09-01

    The morphology, innervation, and neural control of the anterior arterial system of Aplysia californica were investigated. Immunocytochemical and histochemical techniques generated positive reactions in the anterior arterial system for several neuroactive substances, including SCPB, FMRFamide, R15 alpha 1 peptide, dopamine and serotonin. Three neurons were found to innervate the rostral portions of the anterior arterial tree. One is the identified peptidergic neuron R15 in the abdominal ganglion, and the other two are a pair of previously unidentified neurons, one in each pedal ganglion, named pedal arterial shorteners (PAS). The endogeneously bursting neuron R15 was found to innervate the proximal anterior aorta. It also innervates a branch of the distal anterior aorta, the left pedal-parapodial artery. Activity in R15 causes constriction of the left pedal-parapodial artery. This effect is presumed to direct hemolymph towards the genital groove and penis on the right side in vivo. This vasoconstrictor action of R15 is mimicked by the R15 alpha 1 peptide. The PAS neuron pair causes longitudinal contraction of the rostral anterior aorta and the pedal-parapodial arteries. In vivo, the pair is active during behaviors involving head withdrawal and turning. By adjusting the length of the arteries during postural changes, the PAS neurons may prevent disturbances in blood flow due to bending or kinking of the arterial walls. PMID:1359129

  4. Effect of isolated proximal coronary stenotic lesions on distal myocardial perfusion during exercise

    SciTech Connect

    Nichols, A.B.; Buczek, J.A.; Schwann, T.A.; Esser, P.D.; Blood, D.K.

    1988-07-01

    This study tested the hypothesis that the absolute dimension of a coronary stenotic lesion is a more important determinant of its hemodynamic effect on regional myocardial perfusion during exercise than is relative percent stenosis. In 31 patients with an isolated lesion of the left anterior descending coronary artery, regional myocardial perfusion was determined from thallium-201 scans recorded in the left anterior oblique projection after symptom-limited treadmill exercise. Thallium-201 uptake in the distribution of the left anterior descending coronary artery was expressed as a ratio of thallium-201 uptake in the left circumflex artery distribution. Percent area stenosis, minimal cross-sectional area and mean diameter of each stenotic lesion were measured by computer-assisted cinevideodensitometric analysis of projected coronary arteriograms digitized in a 512 X 512 pixel matrix with 256 gray levels. Thallium-201 uptake in the left anterior descending coronary artery distribution, expressed as a ratio, correlated poorly (r = 0.65) with relative percent stenosis, but correlated significantly (r = 0.83; p less than 0.05) with absolute lesion area. For all 16 patients with reduced regional perfusion in the left anterior descending coronary artery distribution during exercise, lesion cross-sectional area was less than 1.8 mm2 (mean 0.9 +/- 0.6); for 13 of the 15 patients with normal distal perfusion, the area of the stenotic lesion was greater than 1.8 mm2 (mean 2.7 +/- 0.7; p less than 0.001). Percent coronary stenosis failed to predict flow-limiting lesions.

  5. Detection of Cardiac Function Abnormality from MRI Images Using Normalized Wall Thickness Temporal Patterns

    PubMed Central

    Wael, Mai; Fahmy, Ahmed S.

    2016-01-01

    Purpose. To develop a method for identifying abnormal myocardial function based on studying the normalized wall motion pattern during the cardiac cycle. Methods. The temporal pattern of the normalized myocardial wall thickness is used as a feature vector to assess the cardiac wall motion abnormality. Principal component analysis is used to reduce the feature dimensionality and the maximum likelihood method is used to differentiate between normal and abnormal features. The proposed method was applied on a dataset of 27 cases from normal subjects and patients. Results. The developed method achieved 81.5%, 85%, and 88.5% accuracy for identifying abnormal contractility in the basal, midventricular, and apical slices, respectively. Conclusions. A novel feature vector, namely, the normalized wall thickness, has been introduced for detecting myocardial regional wall motion abnormality. The proposed method provides assessment of the regional myocardial contractility for each cardiac segment and slice; therefore, it could be a valuable tool for automatic and fast determination of regional wall motion abnormality from conventional cine MRI images. PMID:27034648

  6. Animal models of primary myocardial diseases.

    PubMed

    Liu, S K; Tilley, L P

    1980-01-01

    Feline and canine cardiomyopathies (primary myocardial diseases) were reviewed and divided into three groups based on the clinical, hemodynamic, angiocardiographic, and pathologic findings: (1) feline and canine hypertrophic cardiomyopathy, (2) feline and canine congestive (dilated) cardiomyopathy, and (3) feline restrictive cardiomyopathy. All three groups consisted predominantly of mature adult male cats and dogs. Cardiomyopathy in the hamster and turkey was also reviewed. The most common presenting signs were dyspnea and/or thromboembolism in the cat, systolic murmurs with gallop rhythms on auscultation, cardiomegaly with (groups 1 and 3) or without (group 2) pulmonary edema, abnormal electrocardiograms, elevated left ventricular end-diastolic pressures, and angiocardiographic evidence of mitral regurgitation with left ventricular concentric hypertrophy (group 1), left ventricular dilatation (group 2), or midventricular stenosis (group 3). Some cats in groups 1 and 3 also had evidence of left ventricular outflow obstruction. The principal pathologic findings in all of the cats and dogs were left atrial dilation, hypertrophy, increased septal:left ventricular free wall thickness ratio with disorganization of cardiac muscle cells (group 1); dilatation of the four chambers with degeneration of cardiac muscle cells (group 2); and extensive endocardial fibrosis and adhesion of the left ventricle (group 3). Aortic thromboembolism was commonly observed in the cats of all three groups. These clinical and pathologic findings indicate that cardiomyopathy in the cat or dog is similar to the three forms of cardiomyopathy in humans (hypertrophic, congestive, and restrictive). PMID:6447412

  7. Myocardial contrast echocardiography to assess perfusion in a mouse model of ischemia/reperfusion injury

    NASA Astrophysics Data System (ADS)

    Hossack, John A.; Li, Yinbo; Christensen, Jonathan P.; Yang, Zequan; French, Brent A.

    2004-04-01

    Noninvasive approaches for measuring anatomical and physiological changes resulting from myocardial ischemia / reperfusion injury in the mouse heart have significant value since the mouse provides a practical, low-cost model for modeling human heart disease. In this work, perfusion was assessed before, during and after an induced closed- chest, coronary ischemic event. Ultrasound contrast agent, similar to MP1950, in a saline suspension, was injected via cannulated carotid artery as a bolus and imaged using a Siemens Sequoia 512 scanner and a 15L8 intraoperative transducer operating in second harmonic imaging mode. Image sequences were transferred from the scanner to a PC for analysis. Regions of interest were defined in septal and anterior segments of the myocardium. During the ischemic event, when perfusion was diminished in the anterior segment, mean video intensity in the affected segment was reduced by one half. Furthermore, following reperfusion, hyperemia (enhanced blood flow) was observed in the anterior segment. Specifically, the mean video intensity in the affected segment was increased by approximately 50% over the original baseline level prior to ischemia. Following the approach of Kaul et al., [1], gamma variate curves were fitted to the time varying level of mean video intensity. This foundation suggests the possibility of quantifying myocardial blood flow in ischemic regions of a mouse heart using automated analysis of contrast image data sets. An improved approach to perfusion assessment using the destruction-reperfusion approach [2] is also presented.

  8. Anterior cervical hypertrichosis: a sporadic case

    PubMed Central

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-01-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  9. Anterior surgery for adolescent idiopathic scoliosis.

    PubMed

    Helenius, Ilkka

    2013-02-01

    Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3. PMID:24432061

  10. [Dysphagia in patients undergoing anterior cervical surgery].

    PubMed

    Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Martinato, Geraldo; Riegel, Rafael Ernesto

    2004-06-01

    Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varies depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery. PMID:15273851

  11. Giant Cavernous Haemangioma of the Anterior Mediastinum.

    PubMed

    Kaya, Seyda Ors; Samancılar, Ozgur; Usluer, Ozan; Acar, Tuba; Yener, Ali Galip

    2015-10-01

    Cavernous hemangiomas of the anterior mediastinum is rare. We present a case of a 56-year-old male patient with a giant cavernous hemangioma of the anterior mediastinum, 18 cm in diameters, approached by left posterolateral thoracotomy. To the best of our knowledge, such a unique case has not been previously presented in the literature. PMID:26644773

  12. Giant Cavernous Haemangioma of the Anterior Mediastinum

    PubMed Central

    Kaya, Seyda Ors; Samancılar, Ozgur; Usluer, Ozan; Acar, Tuba; Yener, Ali Galip

    2015-01-01

    Cavernous hemangiomas of the anterior mediastinum is rare. We present a case of a 56-year-old male patient with a giant cavernous hemangioma of the anterior mediastinum, 18 cm in diameters, approached by left posterolateral thoracotomy. To the best of our knowledge, such a unique case has not been previously presented in the literature. PMID:26644773

  13. Anterior cervical hypertrichosis: a sporadic case.

    PubMed

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  14. Collateral circulation as a marker of the presence of viable myocardium in patients with recent myocardial infarction

    SciTech Connect

    Fujita, M.; Ohno, A.; Wada, O.; Miwa, K.; Nozawa, T.; Yamanishi, K.; Sasayama, S. )

    1991-08-01

    The relationship between the presence of viable myocardium and the extent of coronary collateral circulation to the infarct area was evaluated in 20 patients with a recent anterior myocardial infarction who had complete obstruction of the left anterior descending coronary artery. The viability of myocardial tissue was assessed by exercise thallium-201 myocardial scintigraphy, and the collateral circulation was angiographically evaluated by means of a collateral index ranging from 0 to 3. Patients were divided into two groups according to the presence (group 1, n = 10) or absence (group 2, n = 10) of viable myocardium in the perfusion territory of the infarct-related artery. The collateral index in group 1 was 2.5 {plus minus} 0.5 (SD), which was significantly higher than the 0.7 {plus minus} 0.8 in group 2. These findings indicate that the presence of ischemic but viable myocardium is intimately related to the development of collateral circulation in patients with myocardial infarction, and the existence of well-developed collateral channels predicts the presence of viable myocardium in the infarct area.

  15. Echocardiographic prediction of the final event in patients dying of acute myocardial infarction.

    PubMed

    Mimo, R; Sparacino, L; Nicolosi, G L; Cervesato, E; Wei, D R; Grandis, U; Lestuzzi, C; Rellini, G L; Charmet, P A; Zanuttini, D

    1993-06-01

    From an autopsy series of 346 patients who died of acute myocardial infarction, we selected 36 cases for whom echocardiographic data preceding death were available: 17 cases died from a rupture of the left ventricular free wall (group A) and 19 from pump failure (group B). Our aim was to investigate whether any echocardiographic parameter could predict the final event. The total wall motion score, regional wall motion score index and percent of abnormally contracting myocardium were calculated. Diastolic and systolic volumes, ejection fraction and the eccentricity index, as a rough indicator of the left ventricular shape, were also estimated. Interventricular septum and posterior wall thicknesses were also measured. All measured parameters were similar in both groups except posterior wall thickness. Even though an unavoidable selection bias is present in our series, we failed to identify any echocardiographic predictor of the final event in this patient group. PMID:8325304

  16. LV wall segmentation using the variational level set method (LSM) with additional shape constraint for oedema quantification

    NASA Astrophysics Data System (ADS)

    Kadir, K.; Gao, H.; Payne, A.; Soraghan, J.; Berry, C.

    2012-10-01

    In this paper an automatic algorithm for the left ventricle (LV) wall segmentation and oedema quantification from T2-weighted cardiac magnetic resonance (CMR) images is presented. The extent of myocardial oedema delineates the ischaemic area-at-risk (AAR) after myocardial infarction (MI). Since AAR can be used to estimate the amount of salvageable myocardial post-MI, oedema imaging has potential clinical utility in the management of acute MI patients. This paper presents a new scheme based on the variational level set method (LSM) with additional shape constraint for the segmentation of T2-weighted CMR image. In our approach, shape information of the myocardial wall is utilized to introduce a shape feature of the myocardial wall into the variational level set formulation. The performance of the method is tested using real CMR images (12 patients) and the results of the automatic system are compared to manual segmentation. The mean perpendicular distances between the automatic and manual LV wall boundaries are in the range of 1-2 mm. Bland-Altman analysis on LV wall area indicates there is no consistent bias as a function of LV wall area, with a mean bias of -121 mm2 between individual investigator one (IV1) and LSM, and -122 mm2 between individual investigator two (IV2) and LSM when compared to two investigators. Furthermore, the oedema quantification demonstrates good correlation when compared to an expert with an average error of 9.3% for 69 slices of short axis CMR image from 12 patients.

  17. Atraumatic Anterior Dislocation of the Hip Joint

    PubMed Central

    Ohtsuru, Tadahiko; Morita, Yasuyuki; Murata, Yasuaki; Itou, Junya; Morita, Yuji; Munakata, Yutaro; Kato, Yoshiharu

    2015-01-01

    Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case. PMID:26819791

  18. Anterior Segment Imaging in Combat Ocular Trauma

    PubMed Central

    Ryan, Denise S.; Sia, Rose K.; Colyer, Marcus; Stutzman, Richard D.; Wroblewski, Keith J.; Mines, Michael J.; Bower, Kraig S.

    2013-01-01

    Purpose. To evaluate the use of ocular imaging to enhance management and diagnosis of war-related anterior segment ocular injuries. Methods. This study was a prospective observational case series from an ongoing IRB-approved combat ocular trauma tracking study. Subjects with anterior segment ocular injury were imaged, when possible, using anterior segment optical coherence tomography (AS-OCT), confocal microscopy (CM), and slit lamp biomicroscopy. Results. Images captured from participants with combat ocular trauma on different systems provided comprehensive and alternate views of anterior segment injury to investigators. Conclusion. In combat-related trauma of the anterior segment, adjunct image acquisition enhances slit lamp examination and enables real time In vivo observation of the cornea facilitating injury characterization, progression, and management. PMID:24191191

  19. Acute myocardial infarct imaging with indium-111-labeled monoclonal antimyosin Fab

    SciTech Connect

    Khaw, B.A.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Johns, J.A.; Kanke, M.; Barlai-Kovach, M.; Strauss, H.W.; Haber, E.

    1987-11-01

    Indium-111 monoclonal antimyosin Fab scintigraphy was used to detect myocardial necrosis in 52 of 54 patients (96.3%) with acute myocardial infarction. Infarcts were visualized when coronary arteries were persistently occluded (n = 10), became patent after thrombolysis (n = 33), or became patent after spontaneous reperfusion (n = 7). Posteroinferolateral visualizations were obtained in two patients with clinical and enzymatic evidence of infarction but normal electrocardiograms. Of the two patients in whom no infarcts were visualized, one had an anterior myocardial infarct. This patient underwent successful thrombolytic therapy, with attendant minimization of creatine kinase release. The other patient had a small, nonreperfused inferior myocardial infarct. Five patients with a history of remote infarction and acute necrosis showed antimyosin uptake only in regions concordant with the acute episodes of infarction, and radiolabeled antimyosin Fab localized in neither old infarcts nor normal, noninfarcted myocardium. Antimyosin Fab scintigraphy, thus, appears to be a highly specific means of delineating necrotic myocardium, at least in this limited and selected group of patients.

  20. Pbx4 is Required for the Temporal Onset of Zebrafish Myocardial Differentiation

    PubMed Central

    Kao, Robert M.; Rurik, Joel G.; Farr, Gist H.; Dong, Xiu Rong; Majesky, Mark W.; Maves, Lisa

    2015-01-01

    Proper control of the temporal onset of cellular differentiation is critical for regulating cell lineage decisions and morphogenesis during development. Pbx homeodomain transcription factors have emerged as important regulators of cellular differentiation. We previously showed, by using antisense morpholino knockdown, that Pbx factors are needed for the timely activation of myocardial differentiation in zebrafish. In order to gain further insight into the roles of Pbx factors in heart development, we show here that zebrafish pbx4 mutant embryos exhibit delayed onset of myocardial differentiation, such as delayed activation of tnnt2a expression in early cardiomyocytes in the anterior lateral plate mesoderm. We also observe delayed myocardial morphogenesis and dysmorphic patterning of the ventricle and atrium, consistent with our previous Pbx knock-down studies. In addition, we find that pbx4 mutant larvae have aberrant outflow tracts and defective expression of the proepicardial marker tbx18. Finally, we present evidence for Pbx expression in cardiomyocyte precursors as well as heterogeneous Pbx expression among the pan-cytokeratin-expressing proepicardial cells near the developing ventricle. In summary, our data show that Pbx4 is required for the proper temporal activation of myocardial differentiation and establish a basis for studying additional roles of Pbx factors in heart development. PMID:26770887

  1. Post-ischemic treatment with dipyruvyl-acetyl-glycerol decreases myocardial infarct size in the pig.

    PubMed

    Stanley, William C; Kivilo, Krista M; Panchal, Ashish R; Hallowell, Peter H; Bomont, Catherine; Kasumov, Takhar; Brunengraber, Henri

    2003-05-01

    The beneficial effects of pyruvate in organ reperfusion injury have been documented, however the therapeutic use of pyruvate has been hindered by the lack of an appropriate delivery method. Pyruvic acid is unstable and high rates of sodium pyruvate infusion are toxic. Dipyruvyl-acetyl-glycerol (DPAG) ester was developed as a novel method for intravenous pyruvate delivery at a high rate without sodium overload. We tested the ability of DPAG to reduce myocardial infarct size when administered after severe myocardial ischemia in an anesthetized open-chest pig model of ischemia-reperfusion injury. Ischemia was induced by total occlusion of the distal 2/3 of the left anterior descending coronary artery for one hour, followed by two hours of reperfusion. Animals were either untreated (n = 7), or treated with intravenous DPAG (8.0 mg/kg(-1). min(-1), n = 8) during the two hours of reperfusion. Infarct size was measured on blinded samples using tetrazolium staining. The DPAG treated group had elevated pyruvate levels (0.82 +/- 0.07 mM) and reduced infarct size (20.1 +/- 4.2% of the volume at risk, compared to 30.8 +/- 4.6% in the untreated animals (p < 0.05)), with no difference in blood pressure or heart rate between groups. In conclusion, an intravenous infusion of DPAG safely increases arterial pyruvate concentration and reduces myocardial infarct size following myocardial ischemia. PMID:14574079

  2. Ventricular Arrhythmias and Mortality Associated with Isoflurane and Sevoflurane in a Porcine Model of Myocardial Infarction

    PubMed Central

    Regueiro-Purriños, Marta; Fernández-Vázquez, Felipe; de Prado, Armando Perez; Altónaga, Jose R; Cuellas-Ramón, Carlos; Ajenjo-Silverio, Jose M; Orden, Asuncion; Gonzalo-Orden, Jose M

    2011-01-01

    Ischemia of the myocardium can lead to reversible or irreversible injury depending on the severity and duration of the preceding ischemia. Here we compared sevoflurane and isoflurane with particular reference to their hemodynamic effects and ability to modify the effects of acute severe myocardial ischemia and reperfusion on ventricular arrhythmias and mortality in a porcine model of myocardial infarction. Female Large White pigs were premedicated with ketamine, midazolam, and atropine. Propofol was given intravenously for the anesthetic induction, and anesthesia was maintained with isoflurane or sevoflurane. Endovascular, fluoroscopy-guided, coronary procedures were performed to occlude the midleft anterior descending artery by using a coronary angioplasty balloon. After 75 min, the balloon catheter system was withdrawn and the presence of adequate reperfusion flow was verified. The pigs were followed for 2 mo, and overall mortality rate was calculated. The isoflurane group showed lower arterial pressure throughout the procedure, with the difference reaching statistical significance after induction of myocardial ischemia. The ventricular fibrillation rate was higher in isoflurane group (81.3%) than the sevoflurane group (51.7%; relative risk, 1.57 [1.03 to 2.4]). Overall survival was lower in the isoflurane group (75%) than the sevoflurane group (96.4%). In conclusion, in this porcine model of myocardial ischemia and reperfusion, sevoflurane was associated with higher hemodynamic stability and fewer ventricular arrhythmias and mortality than was isoflurane. PMID:21333167

  3. Comparison of radionuclide and enzymatic estimate of infarct size in patients with acute myocardial infarction

    SciTech Connect

    Hirsowitz, G.S.; Lakier, J.B.; Marks, D.S.; Lee, T.G.; Goldberg, A.D.; Goldstein, S.

    1983-06-01

    A comparison was made of the estimated size of the myocardial infarction occurring in 26 patients with a first infarction using creatine kinase (CK) enzyme release between radionuclide gated blood pool measurement of total and regional ventricular function and thallium-201 scintigraphic measurement of myocardial perfusion defects. Creatine kinase estimates of infarct size (enzymatic infarct size) correlated closely with the percent of abnormal contracting regions, left ventricular ejection fraction and thallium-201 estimates of percent of abnormal perfusion area (r . 0.78, 0.69 and 0.74, respectively, p less than 0.01). A close correlation also existed between percent abnormal perfusion area and percent of abnormal contracting regions (r . 0.81, p less than 0.01) and left ventricular ejection fraction (r . 0.69, p less than 0.01). Enzymatic infarct size was larger in anterior (116 +/- 37 CK-g-Eq) than inferior (52 +/- 29 CK-g-Eq) myocardial infarction (p less than 0.01) and was associated with significantly more left ventricular functional impairment as determined by left ventricular ejection fraction (33 +/- 7 versus 60 +/- 10%) (p less than 0.01) and percent abnormal perfusion area (58 +/- 14 versus 13 +/- 12) (p less than 0.01). No significant correlation was observed between enzymatic infarct size and right ventricular ejection fraction. These different methods of estimating infarct size correlated closely with each other in these patients with a first uncomplicated myocardial infarction.

  4. Exercise programme after myocardial infarction.

    PubMed

    Carson, P; Neophytou, M; Tucker, H; Simpson, T

    1973-10-27

    Fifty-nine men with known coronary disease entered an exercise rehabilitation programme. Forty-nine had sustained recent myocardial infarctions, nine had had past myocardial infarcts, and one had had a recent internal mammary implant for severe angina. Each class lasted about 45 minutes and they were held twice weekly; the course for each patient was three months. Sixteen patients dropped out from the course, only three for reasons obviously medical. No deaths or cardiac arrests occurred during the programme. Extrasystoles and angina were detected in a minority of patients and did not constitute reasons for failure to complete the course. The main aim of the study was to show that such a programme is feasible in a district general hospital. Improvement in the morale of patients was impressive and the incidence of return to work high. PMID:4758394

  5. Exercise Programme after Myocardial Infarction

    PubMed Central

    Carson, Peter; Neophytou, Michael; Tucker, Helen; Simpson, Terence

    1973-01-01

    Fifty-nine men with known coronary disease entered an exercise rehabilitation programme. Forty-nine had sustained recent myocardial infarctions, nine had had past myocardial infarcts, and one had had a recent internal mammary implant for severe angina. Each class lasted about 45 minutes and they were held twice weekly; the course for each patient was three months. Sixteen patients dropped out from the course, only three for reasons obviously medical. No deaths or cardiac arrests occurred during the programme. Extrasystoles and angina were detected in a minority of patients and did not constitute reasons for failure to complete the course. The main aim of the study was to show that such a programme is feasible in a district general hospital. Improvement in the morale of patients was impressive and the incidence of return to work high. PMID:4758394

  6. Acute care of myocardial infarction.

    PubMed Central

    Gutman, M. B.; Lee, T. F.; Gin, K.; Ho, K.

    1996-01-01

    Patients with acute myocardial infarct (AMI) need rapid diagnosis and prompt initiation of thrombolytic therapy. Patients with suspected cardiac ischemia must receive a coordinated team response by the emergency room staff including rapid electrocardiographic analysis and a quick but thorough history and physical examination to diagnose AMI. Thrombolysis and adjunct therapies should be administered promptly when indicated. The choice of thrombolytics is predicated by the location of the infarct. PMID:8754702

  7. [Secondary prevention after myocardial infarction].

    PubMed

    Vacheron, André; Bounhoure, Jean-Paul

    2007-11-01

    The mortality rate after myocardial infarction fell sharply with the advent of reperfusion methods and the use of efficient antithrombotic and antiischemic drugs. However, new infarcts, heart failure, arrythmias and sudden death remain frequent, especially in the first two years after the initial event. Large clinical studies have defined and validated therapies for secondary prevention, but the recommended measures are not always properly implemented. Patients with and without ST elevation after myocardial infarction share the same pathophysiologic mechanism, namely atherosclerotic plaque rupture or erosion, with different degrees of superimposed thrombosis and distal embolization. Secondary prevention is the same for these two patient categories. Acute coronary syndromes are associated with an increased risk of adverse cardiovascular outcomes (new myocardial ischemia, left ventricular dysfunction or sudden death) and require aggressive secondary prevention. However, risks factors such as smoking, hypertension, obesity, hypercholesterolemia and diabetes frequently persist. In addition, medical practice does not always respect consensus guidelines. Early risk stratification is necessary to detect residual myocardial ischemia in viable myocardium. After the acute phase, the prognosis depends on the degree of left ventricular dysfunction and the extent and severity of residual ischemia. Exercise and ambulatory electrocardiography, stress echocardiography, perfusion scintigraphy using vasodilator stress, magnetic resonance imaging and coronary angiography are all useful for identifying high-risk patients. Secondary prevention should include risk factor management with lifestyle modifications such as weight reduction, a reduction in saturated fats and an increase in monounsaturated fatty acids. Smoking cessation is crucial, and regular physical activity (30 min per day at least 5 days a week) is beneficial. Cardiac rehabilitation has been shown to improve exercise tolerance and cardiovascular outcome. PMID:18666472

  8. [Infusion of flecainide in a patient with atrial fibrillation and latent Brugada's syndrome has determined modifications of the electrocardiogram similar to those of a septal myocardial infarct].

    TOXLINE Toxicology Bibliographic Information

    Vitiello N; Cirillo R; Fontana D; Granato L; Sestri C; Pagano V; D'Errico L; Carotenuto F; di Palma F

    2003-02-01

    ST-segment elevation in the presence of typical chest pain is a fundamental criterion for the diagnosis of acute myocardial infarction. We describe the case of a 62-year-old male with latent Brugada syndrome in whom the intravenous infusion of flecainide for paroxysmal atrial fibrillation caused ECG abnormalities similar to those of an acute septal myocardial infarction. The patient was not submitted to systemic thrombolysis since accurate echocardiographic evaluation was not suggestive of the presence of any wall motion abnormality and blood analysis did not reveal any increase in the levels of myocardial enzymes. The clinical outcome was not complicated and the patient was finally discharged.

  9. Myocardial Strain Imaging Based on Two-Dimensional Displacement Vector Measurement

    NASA Astrophysics Data System (ADS)

    Nitta, Naotaka; Shiina, Tsuyoshi

    2004-05-01

    The abnormalities of myocardial wall motion caused by changes in wall stiffness often appear in the early stage of ischemic heart disease. Since the myocardium exhibits complex and large motion, a two-dimensional (2D) or three-dimensional (3D) assessment of stiffness distribution is required for accurate diagnosis. Although a 3D assessment is ultimately required, as a stepped approach for practical use, we propose novel methods for tracking the 2D motion using a one-dimensional (1D) phased array and for assessing myocardial malfunction by visualizing the invariant of a strain tensor. The feasibilities of the proposed methods were evaluated by numerically simulating the short-axis imaging of a 3D myocardial model. This model includes a hard infarction located between 1 and 3 o’clock, which is difficult to detect by conventional tissue Doppler and strain rate imaging, and the motions of the model were assigned by referring to actual myocardial motion. These results revealed that the proposed imaging methods clearly depicted the hard infarction area which conventional imaging could not detect.

  10. Effects of exercise training on cardiac function and myocardial remodeling in post myocardial infarction rats

    PubMed Central

    Xu, Xiaohua; Wan, Wenhan; Powers, Anthony S.; Li, Ji; Ji, Lisa; Lao, Shunhua; Wilson, Bryan; Erikson, John M.; Zhang, John Q.

    2008-01-01

    Objective To test the hypothesis that early exercise training after myocardial infarction (MI) could preserve cardiac function, alleviate left ventricular (LV) remodeling and induce a protective effect on morphology. Methods Male Sprague-Dawley rats underwent coronary ligation or sham operation, and were assigned to 3 groups: Sham, sedentary MI (SedMI), and exercise MI (ExMI). We measured the changes in collagen volume fraction, matrix metalloproteinase (MMP) 1, tissue inhibitor matrix metalloproteinase 1 (TIMP-1), angiotensin II receptor type 1 (AT1), and angiotensin converting enzyme (ACE) at gene and protein levels after 8 weeks of exercise training. Cardiac functions were determined by echocardiographic and hemodynamic measurements. Results Early exercise training after MI had no effect on LV wall thinning. Cardiac function was significantly preserved in the ExMI group in comparison to the SedMI group. The collagen volume fraction in the ExMI group was significantly lower than in the SedMI group. Compared to the SedMI group, the ExMI group showed a markedly decrease at both the gene and protein levels in TIMP-1 (P<0.05). No significant differences were found in MMP-1 among the three groups. MMP-1/TIMP-1 ratio in the ExMI group was significantly higher than in the SedMI group. In addition, the expression of AT1 protein in the ExMI group was significantly lower than in the SedMI group. Furthermore, both ACE mRNA expression and ACE binding in the ExMI group are significantly decreased compared to the SedMI group. Conclusions Our results suggest that early exercise training after MI reduces TIMP-1 expression, improves the balance between MMPs and TIMPs, and mitigates the expressions of ACE and AT1 receptor. These improvements, in turn, attenuate myocardial fibrosis and preserve post-MI cardiac function. PMID:17980387

  11. Methodology for jointly assessing myocardial infarct extent and regional contraction in 3-D CMRI.

    PubMed

    Chenoune, Y; Pellot-Barakat, C; Constantinides, C; El Berbari, R; Lefort, M; Roullot, E; Mousseaux, E; Frouin, F

    2012-09-01

    Automated extraction of quantitative parameters from cardiac magnetic resonance images is crucial for the management of patients with myocardial infarct. This paper proposes a postprocessing procedure to jointly analyze Cine and delayed-enhanced (DE) acquisitions, in order to provide an automatic quantification of myocardial contraction and enhancement parameters and a study of their relationship. For that purpose, the following processes are performed: 1) DE/Cine temporal synchronization and 3-D scan alignment, 2) 3-D DE/Cine rigid registration in a region about the heart, 3) myocardium segmentation on Cine-MRI and superimposition of the epicardial and endocardial contours on the DE images, 4) quantification of the myocardial infarct extent (MIE), 5) study of the regional contractile function using a new index, the amplitude to time ratio (ATR). The whole procedure was applied to ten patients with clinically proven myocardial infarction. The comparison between the MIE and the visually assessed regional function scores demonstrated that the MIE is highly related to the severity of the wall motion abnormality. In addition, it was shown that the newly developed regional myocardial contraction parameter (ATR) decreases significantly in delayed enhanced regions. This largely automated approach enables the combined study of regional MIE and left ventricular function. PMID:22829360

  12. ST segment elevation myocardial infarction of a rare aetiology: an unexpected diagnosis.

    PubMed

    Mandal, Kaushik; Karki, Apurwa; Mangla, Aditya

    2015-01-01

    A 43-year-old man presenting with acute coronary syndrome with ST segment elevation myocardial infarction underwent urgent coronary angiography. During the intervention, the patient was found to have several multiple filling defects with dynamic obstruction in the left coronary circulation. Thrombectomy was performed on distal left anterior descending artery and 2nd diagonal artery lesions with balloon angioplasty, which was unsuccessful. Considering the dynamic obstruction in the angiogram, immediate imaging was performed for structural evaluation of the heart. Cardiac CT revealed a circumferential groove on the heart, suggesting an external compression leading to dynamic obstruction of the coronary arteries on angiogram. Cardiac hernia, a very rare aetiology, was suspected to be the culprit for the ST segment elevation myocardial infarction. Thoracoscopy was performed, which revealed congenital cardiac hernia and a fibrous pericardial band encircling the apex. A left mini thoracotomy was performed to release the constriction imposed over the heart, with improvement in circulation. PMID:26420696

  13. Myocardial infarction associated with eosinophilia and plasma extravasation at multiple sites. A variant of Kounis syndrome.

    PubMed

    Gunawardena, Mudalige Don Vajira Malin; Weerasinghe, Anura; Herath, Jagath; Amarasena, Naomali

    2015-01-01

    Myocardial infarction occurring during the course of type I hypersensitivity constitutes Kounis syndrome. We report a case of a 38-year-old man who presented with anterior ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and malaise for several days prior to presentation. There was no urticarial rash or pruritus to suggest hypersensitivity. Coronary angiogram revealed only mild plaque disease. Blood investigations revealed moderate eosinophilia and elevated IgE levels. CT of the thorax revealed fluid extravasation at multiple sites. Screening for a possible secondary cause for eosinophilia revealed hypersensitivity to multiple antigens. A diagnosis of Kounis syndrome was made. Within days of starting steroids and antihistamines, the patient's eosinophil count returned to normal with improvement of clinical picture. This case differs from classical Kounis syndrome as there was no acute allergic reaction (except atopic rhinitis). Fluid extravasation at multiple sites has not been described in previous cases. PMID:25608982

  14. Myocardialization of the cardiac outflow tract

    NASA Technical Reports Server (NTRS)

    van den Hoff, M. J.; Moorman, A. F.; Ruijter, J. M.; Lamers, W. H.; Bennington, R. W.; Markwald, R. R.; Wessels, A.

    1999-01-01

    During development, the single-circuited cardiac tube transforms into a double-circuited four-chambered heart by a complex process of remodeling, differential growth, and septation. In this process the endocardial cushion tissues of the atrioventricular junction and outflow tract (OFT) play a crucial role as they contribute to the mesenchymal components of the developing septa and valves in the developing heart. After fusion, the endocardial ridges in the proximal portion of the OFT initially form a mesenchymal outlet septum. In the adult heart, however, this outlet septum is basically a muscular structure. Hence, the mesenchyme of the proximal outlet septum has to be replaced by cardiomyocytes. We have dubbed this process "myocardialization." Our immunohistochemical analysis of staged chicken hearts demonstrates that myocardialization takes place by ingrowth of existing myocardium into the mesenchymal outlet septum. Compared to other events in cardiac septation, it is a relatively late process, being initialized around stage H/H28 and being basically completed around stage H/H38. To unravel the molecular mechanisms that are responsible for the induction and regulation of myocardialization, an in vitro culture system in which myocardialization could be mimicked and manipulated was developed. Using this in vitro myocardialization assay it was observed that under the standard culture conditions (i) whole OFT explants from stage H/H20 and younger did not spontaneously myocardialize the collagen matrix, (ii) explants from stage H/H21 and older spontaneously formed extensive myocardial networks, (iii) the myocardium of the OFT could be induced to myocardialize and was therefore "myocardialization-competent" at all stages tested (H/H16-30), (iv) myocardialization was induced by factors produced by, most likely, the nonmyocardial component of the outflow tract, (v) at none of the embryonic stages analyzed was ventricular myocardium myocardialization-competent, and finally, (vi) ventricular myocardium did not produce factors capable of supporting myocardialization. Copyright 1999 Academic Press.

  15. Myocardial Infarction in the Elderly

    PubMed Central

    Carro, Amelia; Kaski, Juan Carlos

    2011-01-01

    Advances in pharmacological treatment and effective early myocardial revascularization have –in recent years- led to improved clinical outcomes in patients with acute myocardial infarction (AMI). However, it has been suggested that compared to younger subjects, elderly AMI patients are less likely to receive evidence-based treatment, including myocardial revascularization therapy. Several reasons have been postulated to explain this trend, including uncertainty regarding the true benefits of the interventions commonly used in this setting as well as increased risk mainly associated with comorbidities. The diagnosis, management, and post-hospitalization care of elderly patients presenting with an acute coronary syndrome pose many difficulties at present. A complex interplay of variables such as comorbidities, functional and socioeconomic status, side effects associated with multiple drug administration, and individual biologic variability, all contribute to creating a complex clinical scenario. In this complex setting, clinicians are often required to extrapolate evidence-based results obtained in cardiovascular trials from which older patients are often, implicitly or explicitly, excluded. This article reviews current recommendations regarding management of AMI in the elderly. PMID:22396870

  16. Evaluation of myocardial infarction size with three-dimensional speckle tracking echocardiography: a comparison with single photon emission computed tomography.

    PubMed

    Wang, Qiushuang; Zhang, Chunhong; Huang, Dangsheng; Zhang, Liwei; Yang, Feifei; An, Xiuzhi; Ouyang, Qiaohong; Zhang, Meiqing; Wang, Shuhua; Guo, Jiarui; Ji, Dongdong

    2015-12-01

    To assess whether global and regional myocardial strains from three-dimensional speckle tracking echocardiography (3D-STE) correlate with myocardial infarction size (MIS) detected by single photon emission computed tomography (SPECT). Fifty-seven patients with a history of ST-segment elevation myocardial infarction (MI) within 3-6 months were enrolled, alongside 24 healthy volunteers. Left ventricular (LV) global area strain, global longitudinal strain (GLS), global radial strain, global circumferential strain, left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were measured and compared with the corresponding SPECT-detected MISs. Patients were sub-grouped into massive MIS group (MIS ≥ 12%) and small MIS group (MIS < 12%). Myocardial strains of all the LV segments were compared with the corresponding MIS. Global myocardial strain parameters, LVEF and WMSI of the patients were significantly different from the control group (all P < 0.05) and correlated well with MISs, most significantly for GLS (r = 0.728, P < 0.01). Significant differences in myocardial strain parameters were found between the massive and small MIS groups (all P < 0.05). Receiver operating characteristic curve analysis indicated that GLS had a highest diagnostic value and when the cutoff was -13.8%, the area under the curve was 0.84, with the 70.6% sensitivity and 87.5% specificity. Significant differences of myocardial strain parameters were observed between segments with and without transmural MIs (P < 0.01). 3D-STE myocardial strain parameters evaluated LV global MIS, 3D GLS had the highest diagnostic value. It also preliminarily gauged the degree of ischemia and necrosis of regional myocardial segments. PMID:26288953

  17. Effect of granulocyte colony stimulating EPC on cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction

    PubMed Central

    Zhao, Zilin; Luo, Jianchun; Ma, Lixian; Luo, Xia; Huang, Liangyan

    2015-01-01

    Objective: To study the changes of cardiac function and myocardial energy expenditure following treatment with granulocyte colony stimulating factor (G-CSF) in patients with heart failure after myocardial infarction. Methods: Thirty-eight patients with heart failure after myocardial infarction were randomized into G-CSF treatment group and control group. All the patients received conventional treatment (medication and interventional therapy), and the patients in treatment group were given additional G-CSF (600 ?g/day) for 7 consecutive days. The plasma level of brain-type natriuretic peptide (BNP) and the number of endothelial progenitor cells (EPC) in the peripheral blood were detected before and at 7 days and 4 months after the treatment. The cardiac functions (LVEF, FS, LVIDs, PWTs, EDV, SV, ET) was evaluated by ultrasonic imaging before and at 2 weeks and 4 months after the treatment. The MEE and circumferential end-systolic wall stress (cESS) were calculated by correlation formula. Results: The number of EPC was significantly higher in the treatment group than in the control group after the treatment especially at 7 days (P<0.01). In both groups, BNP level was lowered significantly after the treatment to recover the normal level (P<0.01). The cardiac functions and myocardial energy expenditure were improved in all the patients at 2 weeks and 4 months after the treatment, and the improvement was more obvious in the treatment group (P<0.05), especially in terms of the MEE and cESS was significantly lowered in the treatment group than in the control group after the treatment at 2 weeks (P<0.01), the LVEF and FS was significantly increased in the treatment group than in the control group after the treatment at 4 months (P<0.01). Conclusion: EPC mobilization by G-CSF can effectively improve the cardiac functions, lessen ventricular remodeling and reduce myocardial energy expenditure in patients with heart failure after myocardial infarction. PMID:26629187

  18. Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study

    PubMed Central

    Biederman, Robert W. W.; Young, Alistair A.; Doyle, Mark; Devereux, Richard B.; Kortright, Eduardo; Perry, Gilbert; Bella, Jonathan N.; Oparil, Suzanne; Calhoun, David; Pohost, Gerald M.; Dell’Italia, Louis J.

    2015-01-01

    Background Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P < 0.001) and MR (16.8 ± 3.6 versus 21.6% ± 3.0%, P < 0.005). 3D MR MWCS was lower at the base versus apex (P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions (P < 0.001), contributing to the higher mean global MWCS by MR than echo. MR longitudinal strain was severely depressed in LVH patients (11.0 ± 3.3 versus 16.5% ± 2.5%, P < 0.001) and apical twist was increased (17.5 ± 4.3 versus 13.7 ± 3.7, P < 0.05). Importantly, both circumferential and longitudinal shortening correlated with LV relative wall thickness (R > 0.60, P = 0.001 for both). Conclusions In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction. PMID:27011783

  19. Role of labetalol in acute myocardial infarction

    PubMed Central

    Timmis, A. D.; Fowler, M. B.; Jaggarao, N. S. V.; Vincent, R.; Chamberlain, D. A.

    1982-01-01

    1 The role of labetalol in managing acute myocardial infarction is reviewed. 2 After intravenous infusion labetalol lowers blood pressure in patients with increased blood pressure associated with acute myocardial infarction. 3 Although average heart rate was decreased, cardiac index fell only slightly and stroke index was substantially unchanged. 4 In patients whose pretreatment pulmonary artery end-diastolic pressures were increased, labetalol induced decreases, whereas in the presence of normal pressures, these were unchanged. 5 It is concluded that labetalol infusion in patients with acute myocardial infarction is unlikely to precipitate heart failure and is likely to be of value in reducing myocardial oxygen requirement. PMID:7093093

  20. Halothane inhibits calcium accumulation following myocardial ischemia and calcium paradox in guinea pig hearts

    SciTech Connect

    Hoka, S.; Bosnjak, Z.J.; Kampine, J.P.

    1987-08-01

    This study was performed to test the hypothesis that halothane inhibits calcium accumulation associated with myocardial ischemia and calcium paradox. Using a Langendorff preparation in isolated guinea pig hearts, tissue /sup 45/Ca was measured after 40 and 60 min of loading with /sup 45/Ca, followed by 20 min of washout period. Myocardial ischemia was produced by a 30-min occlusion of the left anterior descending coronary artery (LAD). LAD occlusion caused an increase in /sup 45/Ca content in the anterior left ventricular muscle (ischemic area) of 215% compared to that of the posterior left ventricular muscle (normal myocardium). The increase in /sup 45/Ca content in the ischemic area was significantly less (P less than 0.05) in the presence of halothane (1%) compared to the non-halothane group. Halothane did not significantly alter /sup 45/Ca content in the non-ischemic myocardium. Myocardial injury associated with calcium paradox, which was produced by a 10-min perfusion of the heart with calcium-free Krebs solution followed by normal calcium repletion, caused a significant increase (P less than 0.05) in the /sup 45/Ca content compared to control. Addition of halothane (1%) significantly depressed (P less than 0.05) the increase in /sup 45/Ca content caused by calcium paradox. It is suggested that halothane might inhibit calcium accumulation associated with myocardial ischemia and calcium paradox under certain experimental situations. The inhibitory effect of halothane on calcium accumulation may be beneficial for the ischemic heart during halothane anesthesia.

  1. Pharyngocutaneous fistula after anterior cervical spine surgery

    PubMed Central

    Sansur, Charles A.; Early, Stephen; Reibel, James

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16 months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap. PMID:19330360

  2. Free-Floating Iris Pigmented Epithelial Cyst in the Anterior Chamber

    PubMed Central

    Rotsos, Tryfon; Bagikos, Georgios; Christou, Spyridon; Symeonidis, Chrysanthos; Papadaki, Thekla; Papaeuthimiou, Ioannis; Miltsakakis, Dimitrios

    2016-01-01

    An unusual case of a free-floating peripheral pigmented cyst in the anterior chamber is presented. A 30-year-old Caucasian male presented reporting a visual defect on his right eye in prone position over the past year. Slit-lamp examination revealed a small pigmented free-floating peripheral iris cyst at the 6 o'clock position in the anterior chamber. Ultrasound biomicroscopy revealed an unfixed epithelial pigmented cyst with an extremely thin wall and no internal reflectivity. Due to the lack of severity of visual disturbance of the patient, no surgical treatment was indicated. The patient is to be followed up annually and advised to return immediately in case of pain or any visual symptoms. Free-floating iris cysts in the anterior chamber are uncommon and remain stable in the majority of cases. Management includes only regular observation until any complications arise. PMID:26904334

  3. Free-Floating Iris Pigmented Epithelial Cyst in the Anterior Chamber.

    PubMed

    Rotsos, Tryfon; Bagikos, Georgios; Christou, Spyridon; Symeonidis, Chrysanthos; Papadaki, Thekla; Papaeuthimiou, Ioannis; Miltsakakis, Dimitrios

    2016-01-01

    An unusual case of a free-floating peripheral pigmented cyst in the anterior chamber is presented. A 30-year-old Caucasian male presented reporting a visual defect on his right eye in prone position over the past year. Slit-lamp examination revealed a small pigmented free-floating peripheral iris cyst at the 6 o'clock position in the anterior chamber. Ultrasound biomicroscopy revealed an unfixed epithelial pigmented cyst with an extremely thin wall and no internal reflectivity. Due to the lack of severity of visual disturbance of the patient, no surgical treatment was indicated. The patient is to be followed up annually and advised to return immediately in case of pain or any visual symptoms. Free-floating iris cysts in the anterior chamber are uncommon and remain stable in the majority of cases. Management includes only regular observation until any complications arise. PMID:26904334

  4. Bimanual anterior segment revision surgery for anterior capsule contraction syndrome associated with anterior flexion of intraocular lens haptics

    PubMed Central

    Zinkernagel, M; Papazoglou, A; Patel, C K

    2013-01-01

    Purpose To report the incidence of anterior capsule contraction syndrome (ACCS) and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with ACCS with anterior flexion of the intraocular lens haptics. Methods A consecutive cohort of 268 eyes of 161 patients undergoing phacoemulsification and implantation of the same type of hydrophilic acrylic aspheric intraocular lens cohort were analysed and a novel technique of minimally invasive bimanual technique for anterior segment revision surgery is described. Results We identified four eyes (1.5%) of three patients with advanced ACCS. Successful restoration of a clear visual axis with minimal induction of astigmatism and rapid visual rehabilitation was achieved in all four cases. Conclusion This technique is a safe and minimally invasive alternative to laser or vitrector-cut capsulotomy to restore a clear visual axis. In cases of advanced ACCS, it offers the option for haptic reposition or amputation. PMID:24037236

  5. Trypan blue dye for anterior segment surgeries

    PubMed Central

    Jhanji, V; Chan, E; Das, S; Zhang, H; Vajpayee, R B

    2011-01-01

    Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy and corneal transplantation. This review will discuss the techniques and outcome of TB dye-assisted anterior segment surgeries. PMID:21681214

  6. Long term angiographic and clinical follow up in patients with stent implantation for symptomatic myocardial bridging

    PubMed Central

    Haager, P; Schwarz, E; Dahl, J; Klues, H; Reffelmann, T; Hanrath, P

    2000-01-01

    OBJECTIVE—To assess long term results of coronary stent implantation in patients with symptomatic myocardial bridging.
METHODS—Intracoronary stent implantation was performed within the intramural course of the left anterior descending coronary artery in 11 patients with objective signs of myocardial ischaemia and absence of other cardiac disorders. All had myocardial bridging of the central portion of the left anterior descending coronary artery. Quantitative coronary angiography was performed before and after stent deployment, and again at seven weeks and six months. Clinical evaluation was done at two years.
RESULTS—After stent deployment, quantitative coronary angiography showed absence of systolic compression along the left anterior descending coronary artery; the minimum luminal diameter (mean (SD)) increased from 0.6 (0.3) mm before stent implantation to 1.9 (0.3) mm after implantation (p < 0.05). Intravascular ultrasound showed an increase in cross sectional area from 3.3 (1.3) mm2 at baseline to 6.8 (0.9) mm2 (p < 0.005) after stent deployment. Coronary flow reserve was normalised from 2.6 (0.5) at baseline to 4.0 (0.5) (p < 0.005) after stent implantation. At seven weeks, quantitative coronary angiography showed mild to moderate or severe in-stent stenosis in five of the 11 patients; four of these underwent repeat target vessel revascularisation (percutaneous transluminal coronary angioplasty in two; coronary artery bypass grafting in two). At six months, all patients (n = 9) showed good angiographic results, including those who had target vessel revascularisation. On clinical evaluation at two years, all patients (including those with target vessel revascularisation) remained free of angina and cardiac events.
CONCLUSIONS—Intracoronary stent implantation prevents external compression of bridged coronary artery segments, with increase in luminal diameter and alleviation of symptoms. The incidence of in-stent stenosis requiring target vessel revascularisation (36%) is comparable with that of lesions of 25 mm length in coronary artery disease. The symptom free and event free two year follow up data suggest that stent implantation is a useful way of treating symptomatic patients with myocardial bridges.


Keywords: myocardial bridging; stent; restenosis PMID:10995410

  7. Dronedarone does not affect infarct volume as assessed by magnetic resonance imaging in a porcine model of myocardial infarction.

    PubMed

    Linke, Josefine; Utpatel, Kirsten; Wolke, Carmen; Evert, Matthias; Kühn, Jens-Peter; Bukowska, Alicja; Goette, Andreas; Lendeckel, Uwe; Peters, Barbara

    2015-10-01

    Dronedarone has been demonstrated to be harmful in patients with recent decompensated heart failure. Furthermore, a PALLAS study reported that dronedarone therapy increases mortality rates in patients with permanent atrial fibrillation. Although a pathophysiological explanation for these finding remains to be elucidated, the long term effects of dronedarone on myocardial structure and stability have been suggested. The aim of the present study was to determine whether dronedarone therapy affects left ventricular (LV) function in a chronic model of myocardial infarction (MI). An anterior MI was induced in 16 pigs. Of these animals, eight pigs were then treated with dronedarone for 1 week prior to, and 4 weeks following MI, the remaining pigs served as controls. LV angiography was performed 4 weeks after MI to determine the LV ejection fraction (LVEF). A post‑mortem magnetic resonance imaging scan of the LV was then performed on the two groups (n=6) to determine the volume and size of the induced MI. Dronedarone therapy did not affect systemic and intracardiac hemodynamic parameters or LVEF during the follow‑up assessment. Of note, dronedarone had no negative effect on the total infarct volume and size and did not induce lethal proarrhythmic effects following the induced anterior MI. Therefore, the results suggested that dronedarone did not increase the volume or size of induced anterior MI and did not affect LV performance. Thus, dronedarone therapy was observed to be safe in a porcine model of anterior MI. PMID:26179812

  8. Chronic effects of myocardial infarction on right ventricular function: a noninvasive assessment

    SciTech Connect

    Kaul, S.; Hopkins, J.M.; Shah, P.M.

    1983-10-01

    To assess the chronic effects of myocardial infarction on right ventricular function, 48 subjects were studied utilizing radionuclide angiography and two-dimensional echocardiography. Ten were normal subjects (group I), 11 had previous inferior wall myocardial infarction (group II), 10 had previous anteroseptal infarction (group III), 11 had combined anteroseptal and inferior infarction (group IV) and 6 had extensive anterolateral infarction (group V). The mean (+/- standard deviation) left ventricular ejection fraction was 0.66 +/- 0.03 in group I, 0.58 +/- 0.02 in group II, 0.52 +/- 0.02 in group III, 0.33 +/- 0.03 in group IV and 0.33 +/- 0.01 in group V. No systematic correlation between left and right ventricular ejection fraction was observed among the groups. The mean right ventricular ejection fraction was significantly reduced in the presence of inferior myocardial infarction (0.30 +/- 0.03 in group II and 0.29 +/- 0.03 in group IV compared with 0.43 +/- 0.02 in group I (p less than 0.001)). The group II and IV patients also had increased (p less than 0.001) right ventricular end-diastolic area and decreased (p less than 0.001) right ventricular free wall motion by two-dimensional echocardiography. In the presence of anteroseptal infarction (group III), right ventricular free wall motion was increased (p less than 0.05) compared with normal subjects (group I). Thus, the effects of prior myocardial infarction on right ventricular function depend more on the location of infarction than on the extent of left ventricular dysfunction. Inferior infarction was commonly associated with reduced right ventricular ejection fraction and increased right ventricular end-diastolic area. The right ventricular free wall excursion was increased in the presence of anteroseptal infarction, suggested loss of contribution of interventricular septal contraction to right ventricular ejection.

  9. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  10. How I do it: Anterior pull-through tympanoplasty for anterior eardrum perforations.

    PubMed

    Harris, Jeffrey P; Wong, Yu-Tung; Yang, Tzong-Hann; Miller, Mia

    2016-04-01

    Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003). PMID:26988908

  11. Sheathless transradial coronary angioplasty in an achondroplasic patient with ST elevation myocardial infarction.

    PubMed

    Rahman, Nasir; Nabi, Amjad; Gul, Ibrahim

    2015-01-01

    We present a case of a 50-year-old man with achondroplasia, who presented with anterior ST segment myocardial infarction (STEMI). He was taken urgently to the catheterisation laboratory. Owing to his short stature, it was not possible to insert a radial artery sheath so he underwent a sheathless primary percutaneous coronary intervention (PCI) through the right radial artery, with no complication. He was shifted to the coronary care unit and had an uneventful hospital course. He was discharged in stable condition and follows up regularly as an outpatient. PMID:26508119

  12. MicroRNA-22 targeting CBP protects against myocardial ischemia-reperfusion injury through anti-apoptosis in rats.

    PubMed

    Yang, Jian; Chen, Lihua; Yang, Jun; Ding, Jiawang; Li, Song; Wu, Hui; Zhang, Jing; Fan, Zhixing; Dong, Wusong; Li, Xinxin

    2014-01-01

    MicroRNAs are extensively involved in the pathogenesis of major cardiovascular diseases by suppressing target gene expression. Recent studies have reported that microRNA-22 (miR-22) may be implicated in ischemia-reperfusion (I/R) induced myocardial injury. However, the specific function of miR-22 in myocardial I/R injury is far from clear nowadays. The present study was designed to determine the role of miR-22 in myocardial I/R injury and investigate the underlying cardio-protective mechanism. The rat myocardial I/R injury model was induced by occluding the left anterior descending coronary artery for 30 min followed by 12 h reperfusion. As predicted, adenovirus-mediated miR-22 overexpression markedly reduced the release of creatine kinase and lactate dehydrogenase, infarct size and cardiomyocytes apoptosis. Moreover, CREB binding protein (CBP) as a potential miR-22 target by bioinformatics was significantly inhibited after miR-22 transfection. We also found that p53 acetylation activity, pro-apoptotic related genes Bax and p21 levels were all decreased associated with the down-regulation of CBP. In conclusion, our data demonstrate that miR-22 could inhibit apoptosis of cardiomyocytes through one of its targets, CBP. Thus, miR-22 may constitute a new therapeutic target for the prevention of myocardial I/R injury. PMID:24338162

  13. Myocardial atrio-venous junctions and extensions (sleeves) over the pulmonary and caval veins

    PubMed Central

    Nathan, Hilel; Gloobe, Hanan

    1970-01-01

    The myocardial fibres of the posterior wall of the atrio-venous junctions were examined in 35 large domestic mammals. In the majority of specimens a common pattern in the course and organization of the fibres could be observed. The most obvious features were the following: (1) a main circular fascicle surrounding the pulmonary trunks; (2) fibres encircling the atriovenous junctions; and (3) myocardial sleeves extending along the veins, occasionally as far as the lung. The superior part of the left atrial wall was consistently thicker than the inferior section. Individual variations of this wall between the various trunks followed one of four patterns—vertical, oblique, horizontal or criss-crossed. Differences between mammal and human hearts were found regarding the number of pulmonary trunks, the presence of the oblique vein of the left atrium, and the extension of the myocardial sleeves on the caval vein. This extension on the caval vein continues over the end of the azygos vein in animals. The functional significance of the structures described in this study is discussed. Images PMID:5452285

  14. Myocardial contusion in patients with blunt chest trauma as evaluated by thallium 201 myocardial scintigraphy

    SciTech Connect

    Bodin, L.; Rouby, J.J.; Viars, P.

    1988-07-01

    Fifty five patients suffering from blunt chest trauma were studied to assess the diagnosis of myocardial contusion using thallium 201 myocardial scintigraphy. Thirty-eight patients had consistent scintigraphic defects and were considered to have a myocardial contusion. All patients with scintigraphic defects had paroxysmal arrhythmias and/or ECG abnormalities. Of 38 patients, 32 had localized ST-T segment abnormalities; 29, ST-T segment abnormalities suggesting involvement of the same cardiac area as scintigraphic defects; 21, echocardiographic abnormalities. Sixteen patients had segmental hypokinesia involving the same cardiac area as the scintigraphic defects. Fifteen patients had clinical signs suggestive of myocardial contusion and scintigraphic defects. Almost 70 percent of patients with blunt chest trauma had scintigraphic defects related to areas of myocardial contusion. When thallium 201 myocardial scintigraphy directly showed myocardial lesion, two-dimensional echocardiography and standard ECG detected related functional consequences of cardiac trauma.

  15. Quantitative assessment of myocardial strain with displacement encoding with stimulated echoes MRI in patients with coronary artery disease.

    PubMed

    Miyagi, Hideki; Nagata, Motonori; Kitagawa, Kakuya; Kato, Shingo; Takase, Shinichi; Sigfridsson, Andreas; Ishida, Masaki; Dohi, Kaoru; Ito, Masaaki; Sakuma, Hajime

    2013-12-01

    To determine the diagnostic performance and reproducibility of strain assessment with displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance (CMR) in identifying contractile abnormalities in myocardial segments with late gadolinium enhancement (LGE). DENSE CMR was obtained on short-axis planes of the left ventricle (LV) in 24 patients with suspected coronary artery disease. e1 and e2 strains of LV wall were quantified. Cine MRI was acquired to determine percent systolic wall thickening (%SWT), followed by (LGE) CMR. The diagnostic performance of e1, e2 and %SWT for predicting the presence of LGE was evaluated by receiver operating characteristics (ROC) analysis. Myocardial scar on LGE CMR was observed in 91 (24 %) of 384 segments. The area under ROC curve for predicting the segments with LGE was 0.874 by e1, 0.916 by e2 and 0.828 by %SWT (p = 0.001 between e2 and %SWT). Excellent inter-observer reproducibility was found for strain [Intraclass correlation coefficient (ICC) = 0.962 for e1, 0.955 for e2] as compared with %SWT (ICC = 0.790). DENSE CMR can be performed as a part of routine CMR study and allows for quantification of myocardial strain with high inter-observer reproducibility. Myocardial strain, especially e2 is useful in detecting altered abnormal systolic contraction in the segments with myocardial scar. PMID:23934037

  16. An unusual adverse effect of sildenafil citrate: acute myocardial infarction in a nitrate-free patient.

    PubMed

    Cakmak, Huseyin Altug; Ikitimur, Baris; Karadag, Bilgehan; Ongen, Zeki

    2012-01-01

    Myocardial infarction (MI) associated with sildenafil citrate is seen rarely in patients without any history of coronary artery disease. We report a nitrate-free patient with a history of cardiovascular risk factors who developed acute MI after taking sildenafil. A 44-year-old man diagnosed with acute anterior ST segment elevation MI 120 min after self-administration of 150 mg sildenafil was admitted before attempting any sexual intercourse. The coronary angiography revealed 99% occlusion of the left anterior descending artery (LAD) and a bare-metal stent was implanted. He was discharged after 5 days without any complication. Sildenafil may cause coronary steal or may lead to vasodilation causing hypotension in patient with pre-existing cardiovascular disease, especially in patients on nitrate therapy. Our patient was nitrate free, with normal blood pressure values. Emotional stimulation associated with anticipated sexual activity may have been a triggering factor for vulnerable coronary plaque rupture. PMID:23087267

  17. Assessment of Myocardial Contractile Function Using Global and Segmental Circumferential Strain following Intracoronary Stem Cell Infusion after Myocardial Infarction: MRI Feature Tracking Feasibility Study

    PubMed Central

    Bhatti, Sabha; Al-Khalidi, Hussein; Hor, Kan; Hakeem, Abdul; Taylor, Michael; Quyyumi, Arshed A.; Oshinski, John; Pecora, Andrew L.; Kereiakes, Dean; Chung, Eugene; Pedrizzetti, Gianni; Miszalski-Jamka, Tomasz; Mazur, Wojciech

    2013-01-01

    Background. Magnetic resonance imaging (MRI) strain analysis is a sensitive method to assess myocardial function. Our objective was to define the feasibility of MRI circumferential strain (εcc) analysis in assessing subtle changes in myocardial function following stem cell therapy. Methods and Results. Patients in the Amorcyte Phase I trial were randomly assigned to treatment with either autologous bone-marrow-derived stem cells infused into the infarct-related artery 5 to 11 days following primary PCI or control. MRI studies were obtained at baseline, 3, and 6 months. εcc was measured in the short axis views at the base, mid and apical slices of the left ventricle (LV) for each patient (13 treatments and 10 controls). Mid-anterior LV εcc improved between baseline −18.5 ± 8.6 and 3 months −22.6 ± 7.0, P = 0.03. There were no significant changes in εcc at 3 months and 6 months compared to baseline for other segments. There was excellent intraobserver and interobserver agreement for basal and mid circumferential strain. Conclusion. MRI segmental strain analysis is feasible in assessment of regional myocardial function following cell therapy with excellent intra- and inter-observer variability's. Using this method, a modest interval change in segmental εcc was detected in treatment group. PMID:24959555

  18. Long-term preservation of myocardial energetic in chronic hibernating myocardium.

    PubMed

    Jameel, Mohammad Nurulqadr; Li, Qinglu; Mansoor, Abdul; Xiong, Qiang; Swingen, Cory; Zhang, Jianyi

    2011-03-01

    We previously reported that the myocardial energetic state, as defined by the ratio of phosphocreatine to ATP (PCr/ATP), was preserved at baseline (BL) in a swine model of chronic myocardial ischemia with mild reduction of myocardial blood flow (MBF) 10 wk after the placement of an external constrictor on the left anterior descending coronary artery. It remains to be seen whether this stable energetic state is maintained at a longer-term follow-up. Hibernating myocardium (HB) was created in minipigs (n = 7) by the placement of an external constrictor (1.25 mm internal diameter) on the left anterior descending coronary artery. Function was assessed with MRI at regular intervals until 6 mo. At 6 mo, myocardial energetic in the HB was assessed by (31)P-magnetic resonance spectrometry and myocardial oxygenation was examined from the deoxymyoglobin signal using (1)H-magnetic resonance spectrometry during BL, coronary vasodilation with adenosine, and high cardiac workload with dopamine and dobutamine (DpDb). MBF was measured with radiolabeled microspheres. At BL, systolic thickening fraction was significantly lower in the HB compared with remote region (34.4 ± 9.4 vs. 50.1 ± 10.7, P = 0.006). This was associated with a decreased MBF in the HB compared with the remote region (0.73 ± 0.08 vs. 0.97 ± 0.07 ml · min(-1) · g, P = 0.03). The HB PCr/ATP at BL was normal. DpDb resulted in a significant increase in rate pressure product, which caused a twofold increase in MBF in the HB and a threefold increase in the remote region. The systolic thickening fraction increased with DpDb, which was significantly higher in the remote region than HB (P < 0.05). The high cardiac workload was associated with a significant reduction in the HB PCr/ATP (P < 0.02), but this response was similar to normal myocardium. Thus HB has stable BL myocardial energetic despite the reduction MBF and regional left ventricular function. More importantly, HB has a reduced contractile reserve but has a similar energetic response to high cardiac workload like normal myocardium. PMID:21131472

  19. Correlation of CT-based regional cardiac function (SQUEEZ) with myocardial strain calculated from tagged MRI: an experimental study.

    PubMed

    Pourmorteza, Amir; Chen, Marcus Y; van der Pals, Jesper; Arai, Andrew E; McVeigh, Elliot R

    2016-05-01

    The objective of this study was to investigate the correlation between local myocardial function estimates from CT and myocardial strain from tagged MRI in the same heart. Accurate detection of regional myocardial dysfunction can be an important finding in the diagnosis of functionally significant coronary artery disease. Tagged MRI is currently a reference standard for noninvasive regional myocardial function analysis; however, it has practical drawbacks. We have developed a CT imaging protocol and automated image analysis algorithm for estimating regional cardiac function from a few heartbeats. This method tracks the motion of the left ventricular (LV) endocardial surface to produce local function maps: we call the method Stretch Quantification of Endocardial Engraved Zones (SQUEEZ). Myocardial infarction was created by ligation of the left anterior descending coronary artery for 2 h followed by reperfusion in canine models. Tagged and cine MRI scans were performed during the reperfusion phase and first-pass contrast enhanced CT scans were acquired. The average delay between the CT and MRI scans was <1 h. Circumferential myocardial strain (Ecc) was calculated from the tagged MRI data. The agreement between peak systolic Ecc and SQUEEZ was investigated in 162 segments in the 9 hearts. Linear regression and Bland-Altman analysis was used to assess the correlation between the two metrics of local LV function. The results show good agreement between SQUEEZ and Ecc: (r = 0.71, slope = 0.78, p < 0.001). Furthermore, Bland-Altman showed a small bias of -0.02 with 95 % confidence interval of 0.1, and standard deviation of 0.05 representing ~6.5 % of the dynamic range of LV function. The good agreement between the estimates of local myocardial function obtained from CT SQUEEZ and tagged MRI provides encouragement to investigate the use of SQUEEZ for measuring regional cardiac function at a low clinical dose in humans. PMID:26706935

  20. Phenylephrine-induced anterior chamber hypoxia.

    PubMed

    Pakalnis, V A; Wolbarsht, M L; Landers, M B

    1988-07-01

    The effect of topical phenylephrine 10% solution on anterior chamber oxygen tension (PO2) was studied in cats using an oxygen-sensitive electrode inserted into the midanterior chamber. A decrease in anterior chamber PO2 was usually observed within eight to 25 minutes and declined steadily thereafter. Within two hours, the drug caused a dramatic 60% reduction in anterior chamber oxygen tension (P less than or equal to .0005). We suggest that the mechanism for this phenylephrine-induced anterior chamber hypoxia is reduced blood flow, mediated by the direct vasoconstrictive effect of the drug and compression of the iris vasculature (induced by dilatation). The resulting decrease in the caliber of the iris arteries produced a parallel decrease in blood volume and flow which resulted in diminished PO2. Phenylephrine 10% may contribute to hypoxia and exacerbate the underlying pathology in those disorders where hypoxia plays an important causal role. PMID:3178082

  1. Anterior Cervical Discectomy and Fusion with Plating

    MedlinePlus Videos and Cool Tools

    Anterior Cervical Discectomy and Fusion with Plating Broward Health Medical Center Fort Lauderdale, FL November 17, 2011 I'm Dr. Matthew Moore, head of the Spine Care Center here at North Broward Medical Center. And ...

  2. Computational fluid dynamics simulation of an anterior communicating artery ruptured during angiography.

    PubMed

    Hodis, Simona; Uthamaraj, Susheil; Lanzino, Giuseppe; Kallmes, David F; Dragomir-Daescu, Dan

    2013-01-01

    We present a computational fluid dynamics (CFD) analysis of the hemodynamic environment of an anterior communicating artery that spontaneously ruptured immediately following three-dimensional rotational angiography. Subsequent digital subtraction angiography allowed for the localization of the point of rupture within the aneurysm dome. CFD analysis demonstrated a concentrated jet that impinged directly at the site of rupture. Peak systolic pressure and wall shear stress were both maximal near the rupture location. PMID:23475991

  3. Computational fluid dynamics simulation of an anterior communicating artery ruptured during angiography.

    PubMed

    Hodis, Simona; Uthamaraj, Susheil; Lanzino, Giuseppe; Kallmes, David F; Dragomir-Daescu, Dan

    2014-03-01

    We present a computational fluid dynamics (CFD) analysis of the hemodynamic environment of an anterior communicating artery that spontaneously ruptured immediately following three-dimensional rotational angiography. Subsequent digital subtraction angiography allowed for the localization of the point of rupture within the aneurysm dome. CFD analysis demonstrated a concentrated jet that impinged directly at the site of rupture. Peak systolic pressure and wall shear stress were both maximal near the rupture location. PMID:23493342

  4. Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

    PubMed Central

    2014-01-01

    Background Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Methods In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices. Results IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026). Conclusion IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size. PMID:24708817

  5. Modulation of myocardial contraction by peroxynitrite

    PubMed Central

    Kohr, Mark J.; Roof, Steve R.; Zweier, Jay L.; Ziolo, Mark T.

    2012-01-01

    Peroxynitrite is a potent oxidant that is quickly emerging as a crucial modulator of myocardial function. This review will focus on the regulation of myocardial contraction by peroxynitrite during health and disease, with a specific emphasis on cardiomyocyte Ca2+ handling, proposed signaling pathways, and protein end-targets. PMID:23248603

  6. Quantification of myocardial infarction: a comparison of single photon-emission computed tomography with pyrophosphate to serial plasma MB-creatine kinase measurements

    SciTech Connect

    Jansen, D.E.; Corbett, J.R.; Wolfe, C.L.; Lewis, S.E.; Gabliani, G.; Filipchuk, N.; Redish, G.; Parkey, R.W.; Buja, L.M.; Jaffe, A.S.

    1985-08-01

    Single photon-emission computed tomography (SPECT) with /sup 99m/Tc-pyrophosphate (PPi) has been shown to estimate size of myocardial infarction accurately in animals. The authors tested the hypothesis that SPECT with /sup /sup 99m//Tc-PPi and blood pool subtraction can provide prompt and accurate estimates of size of myocardial infarction in patients. SPECT estimates are potentially available early after the onset of infarction and should correlate with estimates of infarct size calculated from serial measurements of plasma MB-creatine kinase (CK) activity. Thirty-three patients with acute myocardial infarction and 16 control patients without acute myocardial infarction were studied. Eleven of the patients had transmural anterior myocardial infarction, 16 had transmural inferior myocardial infarction, and six had nontransmural myocardial infarction. SPECT was performed with a commercially available rotating gamma camera. Identical projection images of the distribution of 99mTc-PPi and the ungated cardiac blood pool were acquired sequentially over 180 degrees. Reconstructed sections were color coded and superimposed for purposes of localization of infarct. Areas of increased PPi uptake within myocardial infarcts were thresholded at 65% of peak activity. The blood pool was thresholded at 50% and subtracted to determine the endocardial border for the left ventricle. Myocardial infarcts ranged in size from 1 to 126 gram equivalents (geq) MB-CK. The correlation of MB-CK estimates of size of infarct with size determined by SPECT (both in geq) was good (r = .89 with a regression line of y = 13.1 + 1.5x).

  7. [Anterior approaches to the pelvic ring].

    PubMed

    Becker, S C; Holstein, J H; Pizanis, A; Pohlemann, T

    2013-03-01

    Anterior approaches for the stabilization of anterior and also posterior B and C type instability of the pelvic ring were the standard procedures before minimally invasive percutaneous methods supported by image intensifiers or navigation devices were established. Anterior approaches are currently still of high relevance for difficult or impossible closed reductions in multiple trauma surgery where the patient must remain in a supine position. They are also used for stabilization of an increasing number of osteoporotic fractures in the elderly which are no longer only treated in specialized pelvic trauma centres. The anterior as well as the posterior part of the pelvic ring can be stabilized via various anterior approaches. A Pfannenstiel incision is appropriate for plating of ruptures of the pubic symphysis and can be extended to a modified Stoppa approach if necessary. Fractures of the iliac wings can be approached either laterally or less traumatically, via an anterolateral approach. The latter equates the lateral window of the ilioinguinal approach to the acetabulum, allows visualization of the entire sacroiliac joint and therefore stabilization of not only iliosacral luxation but also luxated fractures with a small iliac fragment. By a combination of the different approaches it is possible to simultaneously stabilize ventral and dorsal instabilities in type C fractures of the pelvic ring with a minimal amount of iatrogenic soft tissue trauma. Although the described anterior approaches are considered as simple exact knowledge of the endangered structures and general risks for each approach are essential for a safe exposure of the anatomical region addressed. PMID:23478896

  8. Anterior Eye Imaging with Optical Coherence Tomography

    NASA Astrophysics Data System (ADS)

    Huang, David; Li, Yan; Tang, Maolong

    The development of corneal and anterior segment optical coherence tomography (OCT) technology has advanced rapidly in recently years. The scan geometry and imaging wavelength are both important choices to make in designing anterior segment OCT systems. Rectangular scan geometry offers the least image distortion and is now used in most anterior OCT systems. The wavelength of OCT light source affects resolution and penetration. An optimal choice of the OCT imaging wavelength (840, 1,050, or 1,310 nm) depends on the application of interest. Newer generation Fourier-domain OCT technology can provide scan speed 100-1000 times faster than the time-domain technology. Various commercial anterior OCT systems are available on the market. A wide spectrum of diagnostic and surgical applications using anterior segment OCT had been investigated, including mapping of corneal and epithelial thicknesses, keratoconus screening, measuring corneal refractive power, corneal surgery planning and evaluation in LASIK, intracorneal ring implantation, assessment of angle closure glaucoma, anterior chamber biometry and intraocular lens implants, intraocular lens power calculation, and eye bank donor cornea screening.

  9. Myocardial sestamibi uptake in healthy subjects is related to age, gender and habitus.

    PubMed

    Bouvier, F; Bevegård, S; Nejat, M; Jensen-Urstad, M

    1999-01-01

    The object of this study was to evaluate the effect of gender, age and anthropometric data on regional isotope uptake in myocardial perfusion scintigraphy using 99mTc-MIBI-SPECT (myocardial sestamibi single-photon emission technique). Seventy-one healthy, non-smoking subjects, 42 men and 29 women between 40 and 80 years of age, with less than 5% likelihood of having coronary artery disease were studied. All subjects underwent a maximal exercise and rest MIBI-SPECT using a 2-day protocol and a 180 degrees anterior circular rotation. No correction for scatter or attenuation was made. Normalized regional activity was different in men and women in the anterior and inferior regions, with higher values anteriorly in men and inferiorly in women. Regional activity also differed with age in both women and men with higher relative activity in the anterior regions in the oldest age groups. Higher activities were seen in the basal parts of the left ventricle at rest compared with stress in both men and women. Regional isotope uptake was significantly affected by habitus expressed as body mass index (BMI) and thoracic circumference. Different protocols for stress and rest seem to be needed for men and women in different age groups, and for stress and rest when performing semiquantitative MIBI-SPECT and comparing data with a normal file of healthy subjects. Furthermore, such anthropometric data as BMI and/or thoracic circumference should be considered in order to minimize the risk for false-positive or false-negative scintigraphic results. PMID:10068869

  10. Ventricular function and infarct size: the Western Washington Intravenous Streptokinase in Myocardial Infarction Trial

    SciTech Connect

    Ritchie, J.L.; Cerqueira, M.; Maynard, C.; Davis, K.; Kennedy, J.W.

    1988-04-01

    The Western Washington Intravenous Streptokinase in Acute Myocardial Infarction Trial randomized 368 patients with symptoms and signs of acute myocardial infarction of less than 6 h duration to either conventional care or 1.5 million units of intravenous streptokinase. The mean time to randomization was 209 min and 52% of patients were randomized within 3 h of symptom onset. Quantitative, tomographic thallium-201 infarct size and radionuclide ejection fraction were measured at 8.2 +/- 7.5 weeks in 207 survivors who lived within a 100 mile radius of a centralized laboratory. Overall, infarct size as a percent of the left ventricle was 19 +/- 13% for control subjects and 15 +/- 13% for treatment patients (p = 0.03). For anterior infarction in patients entered within 3 h of symptom onset, infarct size was 28 +/- 13% in the control group versus 19 +/- 15% for the treatment group (p = 0.09). Left ventricular ejection fraction was 47 +/- 15% in the control versus 51 +/- 15% in the treatment group (p = 0.08). For anterior infarction of less than 3 h duration, the ejection fraction was 38 +/- 16% in the control versus 48 +/- 20% in the treatment group (p = 0.13). By statistical analysis incorporating the nonsurvivors, p values for all of these variables were less than or equal to 0.08. There was no benefit for patients with inferior infarction or for anterior infarction of greater than 3 h duration. It is concluded that intravenous streptokinase, when given within 3 h of symptom onset to patients with anterior infarction, reduces infarct size and improves ventricular function.

  11. K-wire assisted split-thickness skin graft harvesting from the anterior trunk.

    PubMed

    Yontar, Yalcin; Coruh, Atilla; Severcan, Mehmet

    2016-02-01

    Split thickness skin graft (STSG) harvesting from the anterior chest and abdominal wall skin is quite a difficult process. The main reason for the difficulty to perform this process is the unsuitable anatomic characteristics of the anterior trunk, such as irregular wavy-like surface over the ribs and lax abdominal wall skin resulting in collapse due to lack of adequate underneath supporting structures when a downward force is applied by the skin graft dermatome. Lower extremity and especially the thigh are generally chosen as the donor site where the STSGs are easily harvested from. However, extensive lower extremity burns, with or without other region burns, preclude harvesting auto STSGs from this invaluable anatomic site. We harvested K-wire assisted STSGs from the anterior chest and abdominal wall skin of 7 patients with lower extremity burns and also a patient that sustained motor vehicle collision. We encountered no problems in any of our patients both intra and postoperatively by using K-wire assisted STSG harvesting. All of the STSGs donor sites healed uneventfully without complications. In our opinion, K-wire assisted STSG harvesting must always be in the tool-box of any surgeon who deals with extensive burns with or without lower extremity burns and extensive traumas of lower extremities. PMID:26608017

  12. Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report.

    PubMed

    Ariyoshi, Dai; Sano, Shigeo; Kawamura, Naohiro

    2016-03-01

    Anterior dislodgement of the transforaminal lumbar interbody fusion (TLIF) cage is one of the severe complications seen in this procedure, which may cause an intraoperative major vessel injury. The objective of this report is to present a rare case of inferior vena cava (IVC) injury during revision surgery for removal of the anteriorly migrated cage. The authors describe a case of 74-year-old woman with lumbar spinal canal stenosis and degenerative scoliosis. During the TLIF surgery, an inserted titanium cage at the L4-5 level dislodged anteriorly to the retroperitoneal space without massive bleeding from the disc space. In the second surgery, which was performed via an anterior retroperitoneal approach to remove the migrated cage, massive torrential bleeding occurred because of IVC injury. The laceration in the posterior wall of the IVC necessitated ligation of this vessel and both common iliac veins by a vascular surgeon. Postoperative edema of the lower extremities after ligation of the vessels was well tolerated, and the patient showed almost full recovery. For removal surgery of an anteriorly migrated cage, the surgeon should be well prepared for the risk of IVC injury, including requesting the attendance of a vascular surgeon. Ligation of the infrarenal IVC is an acceptable solution in irreparable IVC injury. PMID:26637062

  13. Biomarkers of myocardial injury after cardiac arrest or myocardial ischemia.

    PubMed

    Ristagno, Giuseppe; S