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F-18 deoxyglucose and stress N-13 ammonia positron emission tomography in anterior wall healed myocardial infarction  

Microsoft Academic Search

To evaluate myocardial blood flow and glucose utilization, N-13 ammonia (NH3) and F-18 deoxyglucose positron emission tomography scanning was performed in 22 patients with previous anterior wall myocardial infarction, using a high-resolution, multi-slice, whole-body scanner. The N-13 ammonia study was performed at rest and after exercise. The F-18 deoxyglucose study was performed at rest after fasting greater than 5 hours.

T. Fudo; H. Kambara; T. Hashimoto; M. Hayashi; R. Nohara; N. Tamaki; Y. Yonekura; M. Senda; J. Konishi; C. Kawai



Clinical implications of electrocardiograms for patients with anterior wall ST-segment elevation acute myocardial infarction in the interventional era.  


Reperfusion therapy has become an established treatment for ST-segment elevation acute myocardial infarction (STEMI), increasing the need for early diagnosis and early treatment. Despite the development of diagnostic strategies, the electrocardiogram (ECG) plays a central role in the diagnostic pathway for STEMI because it is inexpensive, readily available, and noninvasive. Moreover, in the acute phase of STEMI, the ECG can provide useful information about the extent of area at risk, the degree of myocardial damage, reperfusion injury, and myocardial reperfusion, all of which influence infarct size. This review explores the clinical importance of the ECG for patients with anterior wall STEMI in the current interventional era. PMID:22139364

Kosuge, Masami; Kimura, Kazuo



Comparison of Short and Long-Term Prognosis in Patients With Anterior Wall Versus Inferior or Lateral Wall Non-Q-Wave Acute Myocardial Infarction  

Microsoft Academic Search

We evaluated the early and long-term prognosis of patients with a first non-Q-wave acute myocardial infarction (AMI) in relation to infarct site. Among 4,314 patients with a first AMI, 610 (14%) had a non-Q-wave AMI. Of them, 248 patients with anterior wall AMI were compared with 327 patients with inferior\\/lateral AMI. Baseline clinical characteristics were similar in both groups except



F-18 deoxyglucose and stress N-13 ammonia positron emission tomography in anterior wall healed myocardial infarction  

SciTech Connect

To evaluate myocardial blood flow and glucose utilization, N-13 ammonia (NH3) and F-18 deoxyglucose positron emission tomography scanning was performed in 22 patients with previous anterior wall myocardial infarction, using a high-resolution, multi-slice, whole-body scanner. The N-13 ammonia study was performed at rest and after exercise. The F-18 deoxyglucose study was performed at rest after fasting greater than 5 hours. The N-13 ammonia study revealed a hypoperfused area in 19 of the 22 patients (86%), that corresponded to the infarcted regions as diagnosed by electrocardiography, coronary arteriography and left ventriculography (21 patients). The hypoperfused areas expanded after exercise in 16 of 22 patients (73%). F-18 deoxyglucose uptake was observed in these hypoperfused areas, especially in patients with hypokinetic wall motion on left ventriculography and in exercise-induced hypoperfused areas. However, positron emission tomography demonstrated diffuse uptake of F-18 deoxyglucose in 3 of 8 patients with dyskinetic wall motion. Thus, metabolically active myocardium in infarcted areas or periinfarct ischemia can be visualized with F-18 deoxyglucose and stress N-13 ammonia studies.

Fudo, T.; Kambara, H.; Hashimoto, T.; Hayashi, M.; Nohara, R.; Tamaki, N.; Yonekura, Y.; Senda, M.; Konishi, J.; Kawai, C.



ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion  

Microsoft Academic Search

Ventricular remodeling is a major determinant of the long-term prognosis of patients with acute myocardial infarction (AMI). No previous study examined the relation of ST-segment re-elevation to left ventricular (LV) volume and function in patients with successful reperfusion. We examined the relation of ST-segment re-elevation to LV function and volume indices in 51 patients with anterior wall AMI who underwent

Shigeru Matano; Kohichiro Iwasaki; Shozo Kusachi; Takashi Murakami; Sekiko Kurazono; Hirosuke Yamaji; Hiromi Hamamoto; Toshiyuki Takamura; Kazuyoshi Hina; Takao Tsuji



Occurrence of Guillain-Barre syndrome as an immune mediated complication after thrombolysis with streptokinase for acute anterior wall myocardial infarction: a caution to be vigilant.  


Guillain-Barré syndrome (GBS) constitutes a heterogeneous group of immune-mediated peripheral neuropathic disorders that can be triggered by a variety of antecedent events. Clinical symptoms are thought to result from streptokinase antibody-mediated damage to the local blood-nerve barrier. We report the case of a 50-year-old man with acute anterior wall myocardial infarction who developed GBS as a manifestation of autoimmune hypersensitivity reaction to the drug 17 days after thrombolytic therapy with streptokinase. The patient was treated with a 5-day course of intravenous ? globulin and his symptoms improved and there was no residual deficit. The case forms a reminder of the autoimmune complications of non-fibrin specific agents that can sometimes be catastrophic and require persistent and vigilant in-hospital and immediate postdischarge follow-up and immediate management. PMID:24099761

Kumar, Basant; Agrawal, Navin; Patra, Soumya; Manjunath, C N



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

SciTech Connect

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.

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



Concurrent nitroglycerin administration reduces the efficacy of recombinant tissue-type plasminogen activator in patients with acute anterior wall myocardial infarction  

Microsoft Academic Search

The aim of this study was to evaluate the impact of concurrent nitroglycerin administration on the thrombolytic efficacy of recombinant tissue-type plasminogen activator (rTPA) in patients with acute anterior myocardial infarction (AMI). Sixty patients (53 men, 7 women; mean age 54 ± 7 years) with AMI entered the study. Thirty-three patients were randomized to receive rTPA alone (100 mg in

Francesco Romeo; Giuseppe M. C. Rosano; Eugenio Martuscelli; Fabio De Luca; Cesare Bianco; Corrado Colistra; Michele Comito; Nicola Cardona; Francesco Miceli; Vito Rosano; Jawahar L. Mehta



Effects of the early administration of zofenopril on onset and progression of congestive heart failure in patients with anterior wall acute myocardial infarction. The SMILE Study Investigators. Survival of Myocardial Infarction Long-term Evaluation.  


Chronic congestive heart failure (CHF) is a common disease responsible for a high mortality and morbidity whose clinical course can be improved by angiotensin-converting-enzyme (ACE) inhibition. However, limited data are available on the effects of ACE inhibitors on the onset and progression of CHF in patients with acute myocardial infarction (AMI). The present study was performed as a substudy of the Survival of Myocardial Infarction Long-term Evaluation trial and involved 1,146 patients with anterior wall AMI not undergoing thrombolysis with the exclusion of patients with prior history or clinical signs of CHF on admission. Patients were randomly allocated to treatment with zofenopril (7.5 to 30 mg twice daily) or placebo for a cumulative period of 6 weeks. The prevalence of CHF, either mild to moderate or severe, has been the main objective and has been evaluated 6 weeks and 1 year after AMI. The overall prevalence of CHF was not reduced by zofenopril after both 6 weeks and 12 months. Conversely the prevalence of severe CHF (1.6% vs 2.6%: risk reduction 55.5%; 95% confidence interval 9 to 63; p = 0.0325) and the combined occurrence of death or severe CHF (4.8% vs 8.2%: risk reduction 59%; 95% confidence interval 11 to 71; p = 0.024) were reduced after 6 weeks of treatment with zofenopril. Moreover, the percentage of patients experiencing a deterioration to severe CHF after 1 year was significantly reduced with zofenopril (11.0% vs 24.3%; p = 0.001). In conclusion, the early administration of zofenopril to patients with AMI attenuates the progression of the clinical symptoms of CHF and its clinical consequences, suggesting that ACE inhibitors should be regarded as a suitable strategy for the prevention and treatment of CHF in patients with AMI. PMID:8759812

Borghi, C; Ambrosioni, E; Magnani, B



Spectrum and significance of electrocardiographic patterns, troponin levels, and thrombolysis in myocardial infarction frame count in patients with stress (tako-tsubo) cardiomyopathy and comparison to those in patients with ST-elevation anterior wall myocardial infarction.  


Stress (takotsubo) cardiomyopathy (SC) is a recently recognized syndrome with clinical and electrocardiographic (ECG) presentation resembling ST elevation anterior myocardial infarction. As experience with this condition has evolved, a more diverse spectrum of 12-lead ECG patterns has emerged that may affect differential diagnosis. Fifty-nine consecutive patients with SC were prospectively identified at a large community-based cardiology practice. All were women aged 32 to 90 years (mean 66+/-13) with acute chest pain triggered by emotional or physical incidents and with akinesia of the mid-distal left ventricle; each patient recovered and was discharged within a median of 4 days. On electrocardiography, anterior ST elevation was most common (33 [56%]), with magnitudes less than in controls with left anterior descending coronary artery occlusions (1.4+/-1.5 vs 2.4+/-2.2 mm, p<0.001), with considerable overlap. ECG findings in 26 other patients (44%) without ST elevation revealed diffuse T-wave inversion (10 [17%]) and healed anterior infarctions (6 [10%]) or were nonspecific (5 [8.5%]) or normal (5 [8.5%]). Troponin elevations occurred in 56 patients with SC (95%). The mean peak troponin T level was significantly lower in patients with SC (0.64+/-0.86 ng/ml) than in those with left anterior descending coronary artery occlusions (3.88+/-4.9 ng/ml) (p<0.0001). Patients with SC with or without ST elevation did not differ with respect to the ejection fraction (29+/-9% vs 34+/-9%, respectively, p=NS) or Thrombolysis In Myocardial Infarction (TIMI) frame counts. During recovery, diffuse T-wave inversion evolved in 49 patients with SC (83%). In conclusion, patients with SC present with diverse ECG findings, and no single pattern alone can reliably distinguish this condition from acute coronary syndromes. The diagnosis of SC requires heightened awareness of its unique clinical profile as well as coronary arteriography and left ventriculography. PMID:18549847

Sharkey, Scott W; Lesser, John R; Menon, Madhav; Parpart, Mary; Maron, Martin S; Maron, Barry J



Anterior vaginal wall repair using local anaesthesia  

Microsoft Academic Search

Background: The purpose of the present study was to describe the possibility of surgical repair of anterior vaginal prolapse including amputation of the cervix using local anaesthesia. The description was made according to postoperative complication, recurrence rate, influence on urinary incontinence, and satisfaction of the patient. Material and methods: Eighty-three women were consecutively operated in the anterior wall of the

Susanne Maigaard Axelsen; Karl Møller Bek



Non-Invasive Assessment of Coronary Artery Stenosis with Estimation of Myocardial Wall Stress  

PubMed Central

Background: More diagnostic techniques require a better understanding of the forces and stresses developed in the wall of the left ventricle. The aim of this study was to differentiate significant coronary artery disease (CAD) patients using a non-invasive quantification of myocardial wall stress in the diastole phase. Methods: Sixty male subjects with sinus rhythm (30 patients with significant and 30 with moderate left anterior descending coronary artery stenosis in the proximal portion) as well as 35 healthy subjects as the control group were recruited into the present study. By two-dimensional, pulsed wave, and tissue Doppler echocardiography, the average end-diastolic wall stress was calculated at the left ventricle anterior and interventricular septum wall segments using regional wall thickness, meridional and circumferential radii, and non-invasive left ventricular end-diastolic pressure. Results: A comparison of the calculated end-diastolic myocardial wall stress between the patients with significant and moderate coronary stenosis on the one hand and the healthy subjects on the other showed statistically significant differences in the anterior and septum wall segments (p value < 0.05). The patients with significant left anterior descending coronary artery stenosis had higher end-diastolic myocardial wall stress than did those with moderate stenosis and the healthy group in all the anterior and septum wall segments. Conclusion: It is concluded that non-invasive end-diastolic myocardial wall stress in coronary artery disease patients is an important index in evaluating myocardial performance.

Moladoust, Hassan; Mokhtari-Dizaji, Manijhe; Ojaghi-Haghighi, Zahra; Noohi, Fereidoon



Comparison of location of "culprit lesions" in left anterior descending coronary artery among patients with anterior wall ST-segment elevation myocardial infarction having ramus intermedius coronary arteries versus patients not having such arteries.  


Disturbed, nonlaminar flow distal to arterial bifurcations contributes to atherosclerosis development and progression. We hypothesized that the presence of a ramus intermedius (RI) amplifies the flow disturbances in the proximal left anterior descending (LAD) artery causing more proximal LAD lesions and larger ST-segment elevation myocardial infarction (STEMI). Emory University's contribution to the National Cardiovascular Data Registry was queried for STEMIs from January 2006 to July 2008. The distance from the LAD ostium to the lesion was measured in patients with angiographically visible culprit lesions. The peak troponin-I, creatinine kinase-MB, and left ventricular ejection fraction were used as markers for infarct size. Of the 386 patients with STEMI, 150 had LAD culprit lesions. The mean lesion distance from the LAD ostium was 15.2 +/- 11.0 mm in the patients with RI (n = 44) and 29 +/- 19 mm in those without RI (n = 106; p <0.01). LAD lesions were more proximal in the patients with RI, with 43% and 63% of lesions occurring in the first 10 and 20 mm of the LAD, respectively, versus 10% and 32% in those without RI (p <0.01). Patients with RI had greater peak troponin-I (69 +/- 40 ng/ml vs 50 +/- 39 ng/ml, p = 0.01) and peak creatinine kinase-MB (277 +/- 271 ng/ml vs 174 +/- 190 ng/ml, p = 0.01). A trend was seen toward a lower left ventricular ejection fraction in patients with RI (36 +/- 10% versus 40 +/- 11%, p = 0.06). In conclusion, the presence of RI was associated with more proximal LAD lesions and larger anterior infarctions, suggesting anatomy-induced flow disturbances have important clinical implications. PMID:20598997

Galbraith, Erin M; McDaniel, Michael C; Jeroudi, Ahmad M; Kashlan, Omar R; Suo, Jin; Giddens, Don; Samady, Habib



Intraperitoneal haemorrhage from anterior abdominal wall varices.  

PubMed Central

Patients with oesophageal varices frequently present with gastrointestinal haemorrhage but bleeding from varices at other sites is rare. We present a patient with hepatitis C-induced cirrhosis and partial portal vein occlusion who developed spontaneous haemorrhage from anterior abdominal wall varices into the rectus abdominus muscle and peritoneal cavity. Images Figure 1

Hunt, J. B.; Appleyard, M.; Thursz, M.; Carey, P. D.; Guillou, P. J.; Thomas, H. C.



Electrocardiographic manifestations: acute inferior wall myocardial infarction  

Microsoft Academic Search

The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction

Noelle Rotondo; Marc L Pollack; Theodore C Chan; William J Brady; Richard A Harrigan



A Novel Technique for Anterior Vaginal Wall Prolapse Repair: Anterior Vaginal Wall Darn  

PubMed Central

Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD), which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1?cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP) was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST), Pelvic Organ Prolapse Quantification (POP-Q) evaluation, Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.

Kose, Osman; Saglam, Hasan S.; Kumsar, Sukru; Budak, Salih; Adsan, Oztug



Importance of Total Ischemic Time and Preprocedural Infarct-Related Artery Blood Flow in Predicting Infarct Size in Patients With Anterior Wall Myocardial Infarction (from the CRISP-AMI Trial).  


The goal of this study was to characterize determinants of infarct size in the multicenter randomized Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial. Contemporary determinants of infarct size in patients presenting with acute anterior myocardial infarction without shock and undergoing percutaneous revascularization have been incompletely characterized. In CRISP-AMI, 337 patients with acute anterior ST segment elevation myocardial infarction but without cardiogenic shock at 30 sites in 9 countries were randomized to initiation of intra-aortic balloon counterpulsation before primary percutaneous coronary intervention versus standard of care. The primary outcome was infarct size as measured by cardiac magnetic resonance imaging 3 to 5 days after percutaneous coronary intervention. Of 337 randomized patients, complete periprocedural and infarct size data were available in 250 patients (74%). After a comparison of baseline characteristics to ensure no significant differences, patients with missing data were excluded. Using multiple linear regression of 23 variables, time from symptom onset to first device (? = 0.022, p = 0.047) and preprocedural Thrombolysis In Myocardial Infarction flow 0/1 (? = 15.28, p <0.001) were independent predictors of infarct size. Infarct size increased by 0.43% per 30 minutes in early reperfusion and by 0.63% every 30 minutes in late reperfusion. In conclusion, in patients with acute anterior ST elevation myocardial infraction without cardiogenic shock, total ischemic time and preprocedural Thrombolysis In Myocardial Infarction flow 0/1 were associated with increased infarct size as determined by cardiac magnetic resonance imaging. These findings underscore the importance of systems of care aimed at reducing total ischemic time to open infarct arteries. PMID:23768458

Vemulapalli, Sreekanth; Zhou, Yi; Gutberlet, Matthias; Kumar, Arramraj Sreenivas; Mills, James S; Blaxill, Jonathan; Smalling, Richard; Ohman, Erik Magnus; Patel, Manesh R



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

SciTech Connect

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.

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



Myocardial Wall Tagging With Undersampled Projection Reconstruction  

PubMed Central

Azimuthally undersampled projection reconstruction (PR) acquisition is investigated for use in myocardial wall tagging with MR using grid tags to provide increased temporal and spatial resolution. PR can provide the high-resolution images required for tagging with very few projections, at the expense of artifact. Insight is provided into the PR undersampling artifact, in the context of measuring myocardial motion with tags. For Fourier transform imaging, at least 112 phase-encodings must be collected to image tagging grids spaced 7 pixels apart. PR requires about 80 projections, a 1.4-fold reduction in scan time.

Peters, Dana C.; Epstein, Frederick H.; McVeigh, Elliot R.



Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study  

PubMed Central

OBJECTIVE: Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction. METHODS: The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained. RESULTS: The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant. CONCLUSION: Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate

Sonmez, Osman; Kayrak, Mehmet; Altunbas, Gokhan; Abdulhalikov, Turyan; Alihanoglu, Yusuf; Bacaksiz, Ahmet; Ozdemir, Kurtulus; Gok, Hasan



Significance of U wave polarities in previous anterior myocardial infarction  

SciTech Connect

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.

Kanemoto, N.; Imaoka, C.; Suzuki, Y. (Department of Internal Medicine, Tokai University School of Medicine, Kanagawa (Japan))



Contained rupture of left ventricular false aneurysm after acute myocardial infarction secondary to left anterior descending artery embolism.  


Left ventricular free wall rupture is a rare complication of acute myocardial infarction and accounts for a significant number of fatalities. Pseudoaneurysm is a variety of left ventricular rupture whereby the pericardium seals the defect, forming the wall of the pseudoaneurysm. The diagnosis is usually confirmed with echocardiography, and emergent surgical repair is required in suspected impending rupture. The present report describes the case of a 58-year-old woman who presented with a myocardial infarction due to distal left anterior descending artery occlusion, complicated by ventricular pseudoaneurysm with impending rupture. The patient had an otherwise normal coronary tree. PMID:19052682

Dubreuil, Daniel; Gosselin, Gilbert; Hébert, Yves; Perrault, Louis P



Anomalous Separate Origin of Left Anterior Descending Coronary Artery: Presented as Acute Anterior Myocardial Infarction  

PubMed Central

Coronary artery anomalies are rare presentations in primary percutaneous coronary interventions of acute myocardial infarction. Herein, we report the case of a 59-year-old man with acute anterior myocardial infarction who had anomalous separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) from the left coronary aortic sinus. Coronary angiography showed a normal right coronary artery and LCX, but no visualization of the LAD. After several unsuccessful attempts to cannulate the LAD, we found the LAD ostium located by the side of the LCX ostium. There was total occlusion at proxymal LAD. Coronary computed tomography angiography demonstrated the precise, separate origin of LAD and LCX from the left coronary aortic sinus.

Hong, Man Yong; Kwon, Jang Hoon; Chang, Woo-Sung; Choi, Kyu Un; Song, Yun A; Oh, Kwang Hoon; Lee, Je Hoon



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

SciTech Connect

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.

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



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

SciTech Connect

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.

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



Traumatic intermuscular hernia in the anterior abdominal wall.  

PubMed Central

Traumatic ventral herniae are uncommon. The authors present a patient with traumatic intermuscular hernia in the anterior abdominal wall. Early recognition and differentiation from haematoma is important. In this case, the overlying intact muscle layer masked the classical clinical signs. The incision should be adequate and all internal organs carefully examined. Primary repair is usually possible.

Rao, P S; Kapur, B M



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


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. PMID:2661750

Segall, G M; Davis, M J



Concomitant Use of Intraaortic Balloon Counterpulsation and Streptokinase in Acute Anterior Myocardial Infarction  

Microsoft Academic Search

Using a prospective, nonrandomized design, the authors sought to determine whether concomitant use of intraaortic balloon counterpulsation (IABP) and streptokinase in acute anterior myocardial infarction (MI) would improve the in-hospital mortality rate and angiographic findings. The study included 45 patients with an acute anterior MI. All patients received intravenous streptokinase. Among these, 25 patients had concomitant IABP while the remaining

S. Deniz Kumbasar; Ender Semiz; Oktay Sancaktar; Selim Yalçinkaya; Cengiz Ermi?; Necmi Deger



Myocardial Wall Thickness and Left Ventricular Geometry in Hypertensives  

Microsoft Academic Search

In hypertensive patients the presence of left ventricular (LV) hypertrophy has been associated with a more severe degree of insulin resistance. Whether myocardial wall thickness or LV geometry are associated with a different degree of insulin resistance is still unknown in essential hypertensives. For this reason 26 men with new diagnosed essential hypertension were enrolled. All patients underwent echocardiographic examination

Giuseppe Paolisso; Maurizio Galderisi; Maria Rosaria Tagliamonte; Marcello de Divitis; Domenico Galzerano; Antonio Petrocelli; Pasquale Gualdiero; Oreste de Divitis; Michele Varricchio



Relationships between regional myocardial wall stress and bioenergetics in hearts with left ventricular hypertrophy  

PubMed Central

This study utilized porcine models of postinfarction LV remodeling (MI: n=8) and concentric LVH secondary to aortic banding (AoB: n=8) to examine the relationships between regional myocardial contractile function (tagged MRI), wall stress (MRI and LV pressure), and bioenergetics (P-31 MR spectroscopy). Physiological assessments were conducted at a 4 week time point after myocardial infarction or aortic banding surgery. Comparisons were made with size matched normal animals (normal: n=8). Both myocardial infarction and aortic banding instigated significant LV hypertrophy. Ejection fraction was not significantly altered in the AoB group, but significantly decreased in the MI group (p<0.01 vs. normal and AoB). Systolic and diastolic wall stresses were approximately two times greater than normal in the infarct region and border zone. Wall stress in the AoB group was not significantly different from normal hearts. The infarct border zone demonstrated profound bioenergetic abnormalities, especially in the subendocardium, where the ratio of phosphocreatine to adenosine triphosphate (PCr/ATP) decreased from 1.98 ± 0.16 (normal) to 1.06 ± 0.30 (MI, p<0.01). The systolic radial thickening fraction and the circumferential shortening fraction in the anterior wall were severely reduced (MI, p<0.01 vs Normal). The radial thickening fraction and circumferential shortening fraction in the AoB group were not significantly different from normal. The severely elevated wall stress in the infarct border zone was associated with a significant increase in chemical energy demand and abnormal myocardial energy metabolism. Such severe metabolic perturbations cannot support normal cardiac function, which may explain the observed regional contractile abnormalities in the infarct border zone.

Feygin, Julia; Hu, Qinsong; Swingen, Cory; Zhang, Jianyi



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


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

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



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

SciTech Connect

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.

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



Anticoagulation after Anterior Myocardial Infarction and the Risk of Stroke  

Microsoft Academic Search

BackgroundSurvivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonly patients are discharged on dual antiplatelet therapy. Given the frequency of early coronary reperfusion and risk of bleeding, it remains uncertain whether anticoagulation offers additional utility. We examined the effectiveness of anticoagulation therapy for the prevention of stroke after anterior MI.Methods and FindingsWe

Jacob A. Udell; Julie T. Wang; David J. Gladstone; Jack V. Tu



Acute anterior myocardial infarction after multiple bee stings. A case of Kounis syndrome  

Microsoft Academic Search

A 58-year-old man with no history of cardiac diseases or cardiovascular risk factors was stung by honeybees. Soon after, he gradually developed signs of an allergic reaction followed by severe retrosternal pain. Electrocardiographic, echocardiographic evidence and positive biochemical markers were consistent with an acute anterolateral myocardial infarction. Coronary arteriography showed a left anterior descending artery thrombotic lesion. This is a

Dimitrios Z. Mytas; Pavlos N. Stougiannos; Michael N. Zairis; Georgios Z. Tsiaousis; Stefanos G. Foussas; George N. Hahalis; Nicholas G. Kounis; Vlassios N. Pyrgakis



Advantages of technetium pyrophosphate scintigraphy over plasma enzyme analysis in estimation of anterior myocardial infarct size  

Microsoft Academic Search

Infarct size was estimated by cumulative creatine kinase MB isoenzyme (CKMB-r) release and by technetium 99m stannous pyrophosphate (TcPYP) scintigraphy in 27 patients with acute anterior myocardial infarction. In eight patients, scintigraphy showed a central area of reduced tracer uptake surrounded by a peripheral rim of increased TcPYP accumulation (\\

S Saltissi; P S Robinson; M M Webb-Peploe; D J Coltart; D N Croft



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

SciTech Connect

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.

van Vlies, B.; Baas, J.; Visser, C.A.; van Royen, E.; Delemarre, B.J.; Bot, H.; Dunning, A.J. (Academic Medical Center, Amsterdam (Netherlands))



Mediastinal tracheostomy: unilateral resection of the anterior chest wall.  


Since the first reliable mediastinal tracheostomy described by Grillo et al. in 1966, many new techniques have been described in order to reduce the number of complications. We here report the case of a 55-year-old man who was referred for surgery with post-radiochemotherapy recurrence of a double neoplasm of the pharyngolarynx extending to the proximal trachea and the medial part of the oesophagus. Through a median sternotomy, a pharyngolaryngoesophagectomy was performed with an extended tracheal resection. The reconstruction of the upper digestive tract was performed with a gastric pull-up. The mediastinal tracheostomy was performed with a pectoralis major muscular flap through a right unilateral resection of the manubrium, the right clavicular head and the right first and second costal cartilages. Historically, the mediastinal tracheostomy was performed through a large bilateral resection of the anterior chest wall, in order to prevent the tension on the tracheocutaneous sutures. Nowadays, with the possibility of various pedicled flaps, bilateral resection no longer seems to be necessary. This unilateral resection leads to a reduction in post-operative sequelae. PMID:16354344

Lequeux, T; Chantrain, G; Thill, M P; Saussez, S



Metastatic myocardial abscess on the posterior wall of the left ventricle: a case report  

Microsoft Academic Search

INTRODUCTION: Myocardial abscess is a rare and potentially fatal condition. Metastatic myocardial abscess in the setting of infective endocarditis has been infrequently reported in the medical literature. To the best of the authors' knowledge no case of myocardial abscess affecting the free wall of the left ventricle secondary to infective endocarditis of a right-sided heart valve has been reported previously.

Javaid Iqbal; Iftikhar Ahmed; Wazir Baig



SYNTAX Score Predicts the Left Ventricle Thrombus Development in Patients Undergoing Primary Percutaneous Coronary Intervention for First Anterior Myocardial Infarction.  


Objectives: The aim of this study is to investigate the relationship between left ventricular thrombus (LVT) developments and the SYNTAX score (SS) in patients undergoing primary percutaneous coronary intervention (PPCI) for first anterior wall ST-segment elevation myocardial infarction (STEMI). Methods: We enrolled 160 patients. All participants were evaluated by serial transthoracic echocardiography. Baseline clinical, echocardiographic, and procedural features of PPCI were analyzed to find predictors of LVT development. Results: The LVT was detected in 32 (20%) patients. Left ventricular ejection fraction (LVEF) and SS-I were found to be independent predictors of LVT development. Receiver-operating characteristic curve analysis revealed a cutoff value >19.5 for SS-I (area under the curve: 0.697, 95% confidence interval 0.620-0.767, P < .001) with a specificity of 45.3% and a sensitivity of 84.3%. Conclusion: High SS which was obtained through diagnostic angiogram of PPCI may be associated with LVT development in patients with first anterior wall STEMI. PMID:23434922

Gökdeniz, Tayyar; Boyaci, Faruk; Hatem, Engin; Aslan, Ahmet Oguz; Aykan, Ahmet Çagri; Gül, Ilker; Turan, Turhan; Kalaycioglu, Ezgi; Celik, Sükrü



Myocardial perfusion abnormality in the area of ventricular septum-free wall junction and cardiovascular events in nonobstructive hypertrophic cardiomyopathy.  


Myocardial perfusion abnormality in the left ventricle is known to be prognostic in patients with hypertrophic cardiomyopathy (HCM). Magnetic resonance imaging and necropsy studies on HCM hearts revealed myocardial lesions predominating in the area of ventricular septum-free wall junction. We assessed perfusion abnormality in this area and correlated it with the prognosis of HCM patients. We performed exercise Tc-99m tetrofosmin myocardial scintigraphy in 55 patients with nonobstructive HCM. Perfusion abnormalities were semiquantified using a 5-point scoring system in small areas of anterior junctions of basal, mid, and apical short axis views in addition to a conventional 17-segment model. All patients were prospectively followed for sudden death, cardiovascular death and hospitalization for heart failure or stroke associated with atrial fibrillation. Cardiovascular events occurred in 10 patients during an average follow-up period of 5.7 years. Stress and rest scores from anterior junction, and conventional summed stress score were significantly higher in patients with cardiovascular events than without (all P < 0.05). Anterior junction stress score of >2 produced a sensitivity of 50% and a specificity of 98% for cardiovascular events and was an independent predictor (hazard ratio 8.33; 95% confidence interval, 1.61-43.5; P = 0.01), with rest scores producing similar values, which were higher than summed stress score of >8 (5.68; 1.23-26.3; P = 0.03). The absence of myocardial perfusion abnormality in the narrow area of anterior junction differentiated HCM patients with low-risk. PMID:22187199

Kaimoto, Satoshi; Kawasaki, Tatsuya; Kuribayashi, Toshiro; Yamano, Michiyo; Miki, Shigeyuki; Kamitani, Tadaaki; Matsubara, Hiroaki



Impact of intravenous nitroglycerin on pulsed Doppler indexes of left ventricular filling in acute anterior myocardial infarction  

Microsoft Academic Search

Background Restrictive transmitral Doppler flow patterns are associated with heart failure in acute myocardial infarction (AMI). Methods and Results The objective of this study was to evaluate the effect of intravenous nitroglycerin on the transmitral pulsed Doppler patterns in patients with anterior AMI. Twenty-four patients with anterior AMI were randomly assigned to receive incremental intravenous nitroglycerin or placebo over a

Taysir Garadah; Nitin K. Ghaisas; Naser Mehana; Brendan Foley; Peter Crean; Michael Walsh



Adjuvant materials in anterior vaginal wall prolapse surgery: a systematic review of effectiveness and complications  

Microsoft Academic Search

The objective of this study is to assess the objective recurrence and complications of adjuvant materials in the treatment\\u000a of anterior vaginal wall prolapse. The inclusion criteria were randomised controlled trials (RCTs) using adjuvant materials\\u000a versus standard surgery for anterior vaginal wall prolapse. The main outcome measures were objective recurrence and complications.\\u000a Ten RCTs (1,087 patients) were included in the

Richard Foon; Philip Toozs-Hobson; P. M. Latthe



Concomitant use of intraaortic balloon counterpulsation and streptokinase in acute anterior myocardial infarction.  


Using a prospective, nonrandomized design, the authors sought to determine whether concomitant use of intraaortic balloon counterpulsation (IABP) and streptokinase in acute anterior myocardial infarction (MI) would improve the in-hospital mortality rate and angiographic findings. The study included 45 patients with an acute anterior MI. All patients received intravenous streptokinase. Among these, 25 patients had concomitant IABP while the remaining 20 patients had streptokinase alone. All patients underwent cardiac catheterization. Patients treated with concomitant IABP had a significantly higher frequency of thrombolysis in myocardial infarction (TIMI) grade 3 flow (n: 11; 44% vs n: 1; 5%, p<0.05), and there was a trend toward a lower in-hospital mortality rate in the IABP group (n: 0; 0% vs n: 3; 15%, p=0.08). The angiographic presence of thrombus image and grade > or =2 coronary collateral circulation to the infarct-related coronary artery for the IABP and non-IABP groups did not differ significantly. The preliminary results of this study suggest that concomitant use of IABP and streptokinase in acute anterior MI increases the incidence of TIMI grade 3 flow and may have decreased the in-hospital mortality rate without unacceptable rates of vascular or hemorrhagic complications. PMID:10378822

Kumbasar, S D; Semiz, E; Sancaktar, O; Yalçinkaya, S; Ermi?, C; De?er, N



Right Ventricle Myocardial Performance Index Versus Simpson's Right Ventricle Ejection Fraction in Patients with Isolated Left Ventricle Anterior Myocardial Infarction  

PubMed Central

Introduction: Right ventricle (RV) dysfunction may be secondary to left ventricle (LV) dysfunction in patients of isolated left ventricle anterior myocardial infarction as a consequence of “Ventricular Interdependence”. As RV dysfunction is associated with high in-hospital morbidity and mortality, early recognization of RV dysfunction is warranted; but until today it remains a challenging task because of complex structure and asymmetric shape of RV. Aims and Objectives: Our aim in the present study was to compare Simpson's right ventricle ejection fraction (RVEF) with right ventricle myocardial performance index (RV-MPI) to predict RV function in patients with isolated left ventricle anterior myocardial infarction (LV-AMI). Materials and Methods: We conducted the present study at the Department of Cardiology of Jawahar Lal Nehru Medical College and Associate Group of Hospitals, Ajmer. The control group comprised of twenty five. Age, sex, BMI, pulse and blood pressure matched healthy subjects without history of heart disease, systemic hypertension, diabetes, any other systemic illness and with normal findings in resting and exercise ECG, Echocardiography and Coronary Angiography. Sub-group-1 consisted of 25 patients with hemodynamically significant stenosis of proximal left anterior descending artery (LAD) with patent first septal perforator (S1). Sub-group-2 was composed of s5 patients with hemodynamically significant stenosis of both LAD and left circumflex artery (LCx.). Both subgroups had fully patent right coronary artery (RCA) from proximal to distal end. Results: RV-MPI value determined using pulsed doppler echocardiography was 0.40 ± 0.19 in healthy subjects. However RV-MPI was increased in both subgroups of LV-AMI with significant increase in subgroup-2 (P < 0.005) as compared to subgroup-1 patients (P < 0.01). Simpson's RVEF was not significantly different between the groups (P > 0.05). Conclusion: The findings in this study demonstrate that RV-MPI is a more sensitive, non-geometric echocardiographic parameter than Simpson's RVEF in detecting early RV dysfunction. Early detection of RV dysfunction is important to reduce morbidity and mortality in these patients.

Maheshwari, Monika; Mittal, Sita Ram



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

PubMed Central

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.

Buyukozturk, K; Korkut, F; Meric, M; Deligonul, U; Ozkan, E; Ozcan, R



Increased hyperkinesis in noninfarcted areas during short-term follow-up in patients with first anterior acute myocardial infarction treated by direct percutaneous transluminal coronary angioplasty.  


The time course and clinical significance of hyperkinetic wall motion (HWM) in a noninfarcted area in direct percutaneous transluminal coronary angioplasty (PTCA) has not been clearly demonstrated in patients with acute myocardial infarction (AMI). The objectives of this study were to examine the change in HWM during one-month follow-up after direct PTCA and determine its impact on the recovery of global left ventricular function. A total of 61 patients with first anteroseptal AMI and one vessel disease were evaluated. The paired left ventriculograms in the 30 degrees right anterior oblique view taken both at baseline and follow-up were analyzed by the centerline and area length methods. The severity of hypokinesis was expressed by mean regional wall motion (standard deviation/chord) in most hypocontractile 50% of chords respondable to left anterior descending coronary artery area and HWM by mean regional wall motion in most hypercontractile 50% of chords of noninfarcted area. HWM increased from 0.18 +/- 1.07 to 0.48 +/- 1.30 (p = 0.0608). The delta global ejection fraction (global ejection fraction at follow-up minus global ejection fraction at baseline) was correlated with both delta infarcted wall motion (infarcted wall motion at follow-up minus infarcted wall motion at baseline) and delta HWM (HWM at follow-up minus HWM at baseline) (r = 0.576, p < 0.0001, r= 0.383, p = 0.0036, respectively) during follow-up. Further, the delta global ejection fraction showed better correlation with delta (HWM + infarcted wall motion) [(HWM plus infarcted wall motion at follow-up) minus (HWM plus infarcted wall motion at baseline)] (r= 0.593, p < 0.0001). Direct PTCA resulted in the enhancement of HWVM, which contributed to the increase in the global ejection fraction with the recovery of infarcted wall motion. PMID:10888375

Ito, S; Suzuki, T; Hosokawa, H; Inada, T; Takeda, Y; Suzumura, H; Tomimoto, S; Yamada, Y; Goto, A; Horio, T; Suzuki, S; Fukutomi, T; Itoh, M



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

SciTech Connect

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.

Movahed, A.; Becker, L.C.



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

SciTech Connect

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.

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



Early risk stratification of patients with a first inferior wall acute myocardial infarction  

Microsoft Academic Search

A prognostic index based on admission characteristics of patients with inferior acute myocardial infarction was developed to predict mortality and other major complications during hospitalization. The study sample included 1841 consecutive patients with a first inferior wall acute myocardial infarction, hospitalized in 13 out of 21 operating coronary care units in Israel. Age, angina in the past, congestive heart failure

Micha S Feinberg; Valentina Boyko; Uri Goldbourt; Henrietta Reicher-Reiss; Lori Mandelzweig; Monty Zion; Elieser Kaplinsky; Solomon Behar



The management of anterior chest wall deformity in patients presenting for breast augmentation.  


Anterior chest wall asymmetry is sometimes encountered in patients presenting for consideration of breast augmentation. The chest wall asymmetry or deficiency may be significant enough to consider reconstruction at the same time as breast augmentation in a small number of cases. Customized and prefabricated chest wall implants have been used in a variety of conditions including Poland syndrome, pectus excavatum, and sunken anterior chest. Careful moulage preparation and on-table implant modification are needed to "seat" these implants on the skeletal chest wall under the pectoralis major muscle. The chest wall implant provides a base for the subsequent breast prostheses and fills up a bony deficit that cannot be camouflaged by the breast prostheses alone. PMID:11932625

Hodgkinson, Darryl J



The relationship between myocardial integrated backscatter, perfusion pressure and wall thickness during isovolumic contraction: An isolated pig heart study  

Microsoft Academic Search

To investigate the independent effect of myocardial wall thickness and myocardial perfusion pressure on integrated backscatter, experiments were designed in which integrated backscatter of normally perfused myocardial tissue was measured while changes in wall thickness during the cardiac cycle were reduced to a minimum. In nine blood-perfused isolated pig hearts, perfusion pressure was uncoupled from left ventricular pressure generation (Langendorff

H. Rijsterborgh; R. Krams; F. Mastik; C. T. Lancee; P. D. Verdouw; J. R. T. C. Roelandt; N. Bom



Generation of Myocardial Wall Surface Meshes from Segmented MRI  

PubMed Central

This paper presents a novel method for the generation of myocardial wall surface meshes from segmented 3D MR images, which typically have strongly anisotropic voxels. The method maps a premeshed sphere to the surface of the segmented object. The mapping is defined by the gradient field of the solution of the Laplace equation between the sphere and the surface of the object. The same algorithm is independently used to generate the surface meshes of the epicardium and endocardium of the four cardiac chambers. The generated meshes are smooth despite the strong voxel anisotropy, which is not the case for the marching cubes and related methods. While the proposed method generates more regular mesh triangles than the marching cubes and allows for a complete control of the number of triangles, the generated meshes are still close to the ones obtained by the marching cubes. The method was tested on 3D short-axis cardiac MR images with strongly anisotropic voxels in the long-axis direction. For the five tested subjects, the average in-slice distance between the meshes generated by the proposed method and by the marching cubes was 0.4?mm.

Skrinjar, Oskar; Bistoquet, Arnaud



Asymmetric evolution of anterior chest wall blood supply in female adolescents with progressive right-convex thoracic idiopathic scoliosis  

Microsoft Academic Search

Breast asymmetry was believed to be related to asymmetry of anterior chest wall blood supply and subsequently to aetiology\\u000a of idiopathic thoracic scoliosis in female adolescents. Recent investigations on the anterior chest wall blood supply with\\u000a Colour Doppler Ultrasonography (CDU) in such individuals did not show anatomical and hemodynamic abnormalities. The present\\u000a study investigated the evolution of anterior chest wall

Panagiotis Iliopoulos; Panagiotis Korovessis; Georgios Koureas; Spyridon Zacharatos; Panagiotis Stergiou



The importance of the primary reconstruction of the traumatized anterior maxillary sinus wall.  


This study evaluates the importance of specific posttraumatic reconstruction of the fractured anterior sinus wall. Several methods of different complexity of reconstruction are being compared by means of radiologic, rhinoscopic, and clinical data. Four groups of a total of 207 patients (age, 18-73 years; follow-up average, 4.2 years) with midfacial fractures, divided by operation technique and year, were evaluated. Control groups 1 to 3 received standard procedures without special regard on the reconstruction of the anterior sinus wall; the study group received specific reconstruction. The study group 4 showed a lower complication rate in nearly all measured parameters in comparison to groups 1 and 2. Study group 4 had the smallest incidences of posttraumatic sequelae in radiologic examinations; the clinical outcome was even to group 3. During open reduction and fixation procedures of midfacial fractures, attention should be given to the reconstruction of the anterior sinus wall to avoid postoperative discomfort. PMID:18362733

Ballon, Alexander; Landes, Constantin A; Zeilhofer, Hans F; Herzog, Michael; Klein, Cornelius; Sader, Robert



Single-center 10-year experience in the management of anterior abdominal wall defects  

Microsoft Academic Search

Background  Anterior abdominal wall defects can be managed with various techniques, since no one technique can be applied to all types\\u000a of defects. The aim of this study is to present a single-center experience using biomaterials and evaluate the outcomes.\\u000a \\u000a \\u000a \\u000a Methods  The clinical data obtained from 33 neonates (24 gastroschisis and 9 omphaloceles) managed for anterior abdominal wall defects\\u000a at a single

S. Rahn; M. Bahr; J. Schalamon; A. K. Saxena



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

Microsoft Academic Search

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.

George M. Segall; Michael J. Davis



Sexual function after anterior vaginal wall prolapse surgery  

PubMed Central

OBJECTIVE: The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy. METHODS: Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n?=?29) or traditional colporrhaphy (n?=?27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test. NCT00827528. RESULTS: In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up. CONCLUSIONS: Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.

Feldner, Paulo Cezar; Delroy, Carlos Antonio; Martins, Sergio Brasileiro; Castro, Rodrigo Aquino; Sartori, Marair Gracio Ferreira; Girao, Manoel Joao Batista Castello



Aging Adversely Affects Postinfarction Inflammatory Response and Early Left Ventricular Remodeling after Reperfused Acute Anterior Myocardial Infarction  

Microsoft Academic Search

Background and Aims: We have demonstrated that an increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of left ventricular (LV) remodeling. We sought to clarify the effect of aging on the postinfarction inflammatory response and LV remodeling. Methods: We studied 102 patients who underwent primary angioplasty for a first anterior Q-wave AMI.

Keitaro Mahara; Toshihisa Anzai; Tsutomu Yoshikawa; Yuichiro Maekawa; Teruo Okabe; Yasushi Asakura; Toru Satoh; Hideo Mitamura; Masahiro Suzuki; Akira Murayama; Satoshi Ogawa



Dissociation Between Changes in Intramyocardial Function and Left Ventricular Volumes in the Eight Weeks After First Anterior Myocardial Infarction  

Microsoft Academic Search

Objectives. We sought to examine the relation between regional changes in intramyocardial function and global left ventricular (LV) remodeling in the first 8 weeks after reperfused first anterior myocardial infarction (MI).Background. Because of limitations in imaging methods used to date, this relation has not been thoroughly evaluated.Methods. We studied 26 patients (21 men, 5 women; mean age 51 years) by

Christopher M Kramer; Walter J Rogers; Therese M Theobald; Thomas P Power; Gennady Geskin; Nathaniel Reichek



Giant anterior chest wall basal cell carcinoma: a reconstructive challenge and review of the literature.  


Giant basal cell carcinomas (GBCC) are rare, accounting for <1% of BCCs. Those occurring on the anterior chest wall are a very rare subset that brings particular reconstructive challenges. We describe a 75-year-old man whose 13.5 cm diameter ulcerating GBCC on his left anterior chest came to medical attention following a fall. The lesion was resected en-bloc with adjacent ribs, and reconstructed with an omental flap, superiorly pedicled vertical rectus abdominus myocutaneous (VRAM) flap and split skin grafting. While the myriad reasons for delayed presentation of giant cutaneous malignancies are well documented, the complex nature of reconstruction and requirement for an integrated multidisciplinary approach are less so. It is of importance to note that the cicatricial nature of these lesions may result in a much larger defect requiring reconstruction than appreciated prior to resection. Documented cases of anterior chest wall GBCC and the treatment strategies employed are reviewed. PMID:23598936

Warbrick-Smith, James; O'Neill, Jennifer K; Wilson, Paul



Fistula between anterior rectum wall and seminal vesicles as a rare complication of low-anterior resection of the rectum  

PubMed Central

Laparoscopic surgery has become a frequently used modality for rectal tumour surgery. A fistula between the rectum and lower urinary tract is one of the possible complications, with rectovesical fistulas occurring most frequently. This case report presents a 66-year-old man who underwent a laparoscopic low-anterior resection of the rectum due to the presence of a polyp with a high risk of malignant transformation. At the time of discharge on the eleventh postoperative day, the patient returned to the hospital with a fever, scrotal swelling and pain in the right hemiscrotum. These symptoms began four hours after discharge from the hospital. There was no sign of faecaluria. The presence of gas in the urinary bladder was confirmed after catheter insertion. The patient was diagnosed with a fistula between the anterior wall of the rectum and seminal vesicles. The diagnosis was based on cystoscopy findings, X-ray and computed tomography irrigography. The condition was treated conservatively by suprapubic insertion of a catheter and antibiotics. The total length of the treatment, including management of subsequent complications, was 4 months. Twelve months after the complication developed, the patient is symptom free, without urinary tract infection recurrence, and is under the care of both surgery and urology clinics. We describe the clinical symptoms, possibilities of treatment and the result of treatment of this rare complication of rectum low-anterior resection, which has never been described in the literature before.

Krhut, Jan; Jonszta, Tomas; Nemec, David; Havranek, Ondrej; Martinek, Lubomir



A technique for laparoscopic repair of herniation of the anterior abdominal wall using a composite mesh prosthesis  

Microsoft Academic Search

Improved laparoscopic techniques have engendered many new gastrointestinal and other intracavity abdominal procedures. Groin hernias have also been repaired with the assistance of the laparoscope via both transperitoneal and properitoneal approaches, but less emphasis has been placed upon repair of hernias of the anterior abdominal wall. A technique for the transperitoneal, laparoscopic repair of anterior abdominal wall hernias using a

Philip S. Barie; Charles A. Mack; William A. Thompson



Automatic Quantitation of Regional Myocardial Wall Motion and Thickening From Gated Technetium99m Sestamibi Myocardial Perfusion Single-Photon Emission Computed Tomography  

Microsoft Academic Search

Objectives. We developed an automatic quantitative algorithm for the measurement of regional myocardial wall motion and wall thickening from three-dimensional gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomographic images.Background. The algorithm measures the motion of the three-dimensional endocardial surface using a modification of the centerline method, as well as wall thickening using both geometry (gaussian fit) and partial volume

Guido Germano; Jacob Erel; Howard Lewin; Paul B. Kavanagh; Daniel S. Berman



A new option for autologous anterior chest wall reconstruction: the composite thoracodorsal artery perforator flap.  


Sternal chondrosarcoma is rare and often requires total or subtotal sternectomy. The authors describe the case of a 70-year-old man with sternoclavicular joint chondrosarcoma who underwent subtotal sternectomy with partial resection of the two clavicles and anterior arches of first to third right ribs. Anterior chest wall reconstruction was performed with a composite thoracodorsal artery perforator free flap with sixth and seventh ribs vascularized on serratus muscle. The postoperative course was uneventful. Seven months after surgery, the patient was doing well. This surgical procedure is a new option for autologous reconstruction without prosthetic material after extensive sternectomy. PMID:22365019

Dast, Sandy; Berna, Pascal; Qassemyar, Quentin; Sinna, Raphael



Management of Anterior Abdominal Wall Defect Using a Pedicled Tensor Fascia Lata Flap: A Case Report  

PubMed Central

Degloving injuries to anterior abdominal wall are rare due to the mechanism of injury. Pedicled tensor fascia lata is known to be a versatile flap with ability to reach the lower anterior abdomen. A 34-year-old man who was involved in a road traffic accident presented with degloving injury and defect at the left inguinal region, sigmoid colon injury, and scrotal bruises. At investigation, he was found to have pelvic fracture. The management consisted of colostomy and tensor fascia lata to cover the defect at reversal. Though he developed burst abdomen on fifth postoperative day, the flap healed with no complications.

Ojuka, K. D.; Nangole, F.; Ngugi, M.



Giant Desmoid Tumor of the Anterior Abdominal Wall in a Young Female: A Case Report  

PubMed Central

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5?kg treated surgically with successful outcome.

Koshariya, Mahim; Shukla, Samir; Khan, Zuber; Vikas, Vaibhav; Pratap Singh, Avinash; Baghel, Puspendra; Pendro, Varun; Kirti Jain, Vishal; Jagdish Jai, Shrikant; Kumar, Sanjeev; Songra, M. C.



Giant desmoid tumor of the anterior abdominal wall in a young female: a case report.  


Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5?kg treated surgically with successful outcome. PMID:23710408

Koshariya, Mahim; Shukla, Samir; Khan, Zuber; Vikas, Vaibhav; Pratap Singh, Avinash; Baghel, Puspendra; Pendro, Varun; Kirti Jain, Vishal; Jagdish Jai, Shrikant; Kumar, Sanjeev; Songra, M C



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

Microsoft Academic Search

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%)

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



Effects of nisoldipine and\\/or enalapril on left ventricular function and exercise capacity in patients with recent anterior myocardial infarction and mild cardiac dysfunction  

Microsoft Academic Search

Treatment of abnormal remodeling and dysfunction of left ventricle after myocardial infarction is one of the major goals of recent therapeutic interventions. The current study, the Nisoldipine Enalapril Anterior Myocardial Infarction Study pilot investigation, was designed to investigate the effects of 12 weeks of treatment with enalapril or nisoldipine or their combination on left ventricular (LV) function and exercise capacity

Massimo Romano; Stefania Cardei; Elisabetta de Arcangelis; Ida Monteforte; Marianunzia Capaldo; Pietro Muto; Raffaele Marchegiano; Michael Ochan Kilama; Mario Condorelli



Extent of regional wall motion abnormalities by gated spect in patients with Q-wave myocardial infarction  

Microsoft Academic Search

Background: Regional wall motion abnormalities (RWMA) on post stress gated SPECT enhance detection of myocardial ischemia. However, the extent of RWMA in patients (pts) with a prior electrocardiography (EKG) Q-wave myocardial infarction (Q-MI) on gated SPECT is not known. We studied this on post stress gated SPECT myocardial perfusion (MPI) studies in pts with a Q-MI by EKG.Methods: Thirty pts

J Mahenthiran; J. C Elliott; S Jacob; S Stricker; V. G Kalaria; S Sawada



A new description of the anterior abdominal wall in man and mammals.  

PubMed Central

The ventral abdominal walls of 116 specimens (41 human and 75 from nine mammalian families) of various ages and both sexes were studied anatomically and histologically. In man, each abdominal aponeurosis was bilaminar, and each wall of the rectus sheath was trilaminar (plywood-like). The two layers of the internal oblique emerged, in part of its extent, superficial to the external oblique and also passed deep to the transversus abdominis. All the six aponeurotic layers were oblique and crossed the mid-line, forming the following digastric muscles: the two external obliques together, the two transversus abdominis muscles together, one internal oblique (anterior layer) with the opposite external oblique (posterior layer) and one internal oblique (posterior layer) with the opposite transversus abdominis (anterior layer). The linea alba might be considered less the insertion of the abdominal muscles, but rather the common area of decussation of their intermediate aponeuroses. In all mammals, the internal oblique aponeurosis passed either superficial to that of the external oblique or deep to that of the transversus. The transversus aponeurosis was always oblique and in all eutheria it split into two layers. All abdominal aponeuroses crossed the middle line forming digastric muscles between the two sides. The functional significance and surgical application of these findings are discussed. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15

Rizk, N N



Rapid Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction by Echocardiographic Wall Motion Analysis  

Microsoft Academic Search

Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculography (RNV) and contrast ventriculography measurements of LVEF for comparison. ECHO-LVEF from the 41 patients correlated well with the reference

Jens Berning; Jens Rokkedal Nielsen; Jeppe Launbjerg; Jan Fogh; Hans Mickley; Poul Erik Andersen



Pharmacologic stress-induced regional myocardial blood flow heterogeneity and left ventricular wall thickening abnormality: Comparison of intravenous adenosine with dipyridamole in a model of critical coronary stenosis  

Microsoft Academic Search

Variations in reported sensitivity of myocardial perfusion scans or wall motion abnormalities during pharmacologic stress with intravenous adenosine and dipyridamole may be caused by differences in myocardial oxygen demand or myocardial blood flow redistribution induced by each agent. To investigate the physiologic correlates of functional abnormalities during pharmacologic stress testing, regional myocardial blood flow (radiolabeled microsphere technique) and left ventricular

Elizabeth O. Ofili; Frederick A. Dressler; Jeanette A. St. Vrain; Henry Goodgold; John Standeven; Bhugol Chandel; Rita Gentilcore; Lawrence McBride; Ramon Castello; Morton Kern; Arthur J. Labovitz



Reversal of ischaemic systolic and diastolic left ventricular dysfunction by successful coronary angioplasty in patients with non-Q wave anterior myocardial infarction.  


The effect of PTCA on global and regional left ventricular systolic function, isovolumic relaxation, chamber and muscle stiffness were studied in 30 patients with angina pectoris, previous non-Q wave anterior myocardial infarction (AMI) and significant stenosis of the left anterior descending coronary artery (LAD). In 11 of the 30 patients the condition was stable, but it was unstable in 19. Left ventricular angiograms were obtained before and 4.85 +/- 3.67 months after PTCA. The RAO was in the 30 degree projection, with the silhouette of the left ventricle sliced into 90 regions; changes in left ventricular volume, pressure and anterior wall thickness during the full cardiac cycle, together with dp/dt were demonstrated. After PTCA, global ejection fraction increased from 68.77 +/- 5.96% to 76.57 +/- 3.18%, P < 0.001. Impaired contractility was found in 29/90 (32.2%) regions before PTCA and in 5/90 (5.6%) after PTCA, P < 0.001. The time constant of the isovolumic pressure fall decreased after PTCA (52.56 +/- 17.40 ms vs 39.61 +/- 11.26 ms, P < 0.01). Elastic chamber stiffness coefficient decreased (0.022 +/- 0.003 vs 0.008 +/- 0.004, P < 0.001) and peak rate of left ventricular filling increased (319.0 +/- 107.9 ml.min-1 vs 396.8 +/- 201.4 ml.min-1, P < 0.05) after PTCA. The muscle stiffness coefficient was within normal values before and did not change after PTCA. The study findings show that in patients with persistent angina pectoris after non-Q wave AMI, complex systolic and diastolic ischaemic dysfunction occurs. This dysfunction can be reversed after successful PTCA of LAD. PMID:7988603

Witkowski, A; Ruzy??o, W; Górecka, B; Chmielak, Z; Jodkowski, J; Dabrowski, M; Woroszylska, M; Debski, A; Demkow, M; Ciszewski, A



Comparative histological analysis of anterior vaginal wall in women with pelvic organ prolapse or control subjects. A pilot study  

Microsoft Academic Search

The purpose of this study was to compare smooth muscle content of anterior vaginal wall in women with pelvic organ prolapse\\u000a (POP) and control subjects. Specimens were taken in the midline from the apex of anterior vaginal cuff from eleven women with\\u000a POP and eight control subjects operated for hysterectomy without prolapse. Masson’s trichrome stain was used to determine\\u000a the

Wassim Badiou; Guillaume Granier; Philippe-Jean Bousquet; Xavier Monrozies; Pierre Mares; Renaud de Tayrac



The relationship between myocardial integrated backscatter, perfusion pressure and wall thickness during isovolumic contraction: an isolated pig heart study.  


To investigate the independent effect of myocardial wall thickness and myocardial perfusion pressure on integrated backscatter, experiments were designed in which integrated backscatter of normally perfused myocardial tissue was measured while changes in wall thickness during the cardiac cycle were reduced to a minimum. In nine blood-perfused isolated pig hearts, perfusion pressure was uncoupled from left ventricular pressure generation (Langendorff method) and isovolumic contraction and relaxation were realized by inserting a noncompressible water-filled balloon into the left ventricle. In a first experiment, at constant perfusion pressure (85 mmHg), the integrated backscatter (3-7 MHz), the myocardial wall thickness and the left ventricular pressure were determined simultaneously at various balloon volumes (5-25 mL). A quasistatic increase of balloon volume by 50% resulted in an average decrease of wall thickness of 6.5% (p < 0.01) and a mean increase in the integrated backscatter level of 1.1 dB (p < 0.01). Integrated backscatter levels increased statistically significant by 0.14 +/- 0.014 dB per percent decrease of wall thickness. Measurements of percentage end-systolic myocardial wall thickening ranged from -10% to +10%, mean 0.15 +/- 4.5% (NS from zero); whereas cyclic variation of integrated backscatter ranged from -3.9 to +3.9 dB, mean 0.19 +/- 1.5 dB (NS from zero). In a second experiment, at a constant midrange balloon volume, the same parameters were determined simultaneously at various perfusion pressures (20-120 mmHg). An increase in perfusion pressure by 50% resulted in a small but statistically significant increase of 1.5% in myocardial wall thickness, which could be explained by an increase of intravascular volume. The integrated backscatter levels did not change statistically significantly. Measurements of percentage end-systolic myocardial wall thickening ranged from -8.9 to +7.8%, mean 0.13 +/- 4.0% (NS from zero); whereas cyclic variation of integrated backscatter ranged from -1.8 to +4.2 dB, mean 0.37 +/- 1.3 dB (NS from zero). The magnitude of cyclic variation of integrated backscatter of myocardial tissue in a contractile state is reduced if myocardial muscle is prevented from normal thickening. In addition, changes in intravascular volume during the cardiac cycle have a negligible influence on the absolute backscatter level or its cyclic variation. We conclude, if only wall thickness and perfusion pressure are involved, that integrated backscatter is mainly determined by myocardial wall thickness. PMID:8928316

Rijsterborgh, H; van der Steen, A F; Krams, R; Mastik, F; Lancée, C T; Verdouw, P D; Roelandt, J R; Bom, N



Automatic Delineation of the Myocardial Wall From CT Images Via Shape Segmentation and Variational Region Growing.  


Prognosis and diagnosis of cardiac diseases frequently require quantitative evaluation of the ventricle volume, mass, and ejection fraction. The delineation of the myocardial wall is involved in all of these evaluations, which is a challenging task due to large variations in myocardial shapes and image quality. In this paper, we present an automatic method for extracting the myocardial wall of the left and right ventricles from cardiac CT images. In the method, the left and right ventricles are located sequentially, in which each ventricle is detected by first identifying the endocardium and then segmenting the epicardium. To this end, the endocardium is localized by utilizing its geometric features obtained on-line from a CT image. After that, a variational region-growing model is employed to extract the epicardium of the ventricles. In particular, the location of the endocardium of the left ventricle is determined via using an active contour model on the blood-pool surface. To localize the right ventricle, the active contour model is applied on a heart surface extracted based on the left ventricle segmentation result. The robustness and accuracy of the proposed approach is demonstrated by experimental results from 33 human and 12 pig CT images. PMID:23744658

Zhu, Liangjia; Gao, Yi; Appia, Vikram; Yezzi, Anthony; Arepalli, Chesnal; Faber, Tracy; Stillman, Arthur; Tannenbaum, Allen



Myocardial wall thickening from gated magnetic resonance images using Laplace's equation  

NASA Astrophysics Data System (ADS)

The aim of our work is to present a robust 3D automated method for measuring regional myocardial thickening using cardiac magnetic resonance imaging (MRI) based on Laplace's equation. Multiple slices of the myocardium in short-axis orientation at end-diastolic and end-systolic phases were considered for this analysis. Automatically assigned 3D epicardial and endocardial boundaries were fitted to short-axis and long axis slices corrected for breathold related misregistration, and final boundaries were edited by a cardiologist if required. Myocardial thickness was quantified at the two cardiac phases by computing the distances between the myocardial boundaries over the entire volume using Laplace's equation. The distance between the surfaces was found by computing normalized gradients that form a vector field. The vector fields represent tangent vectors along field lines connecting both boundaries. 3D thickening measurements were transformed into polar map representation and 17-segment model (American Heart Association) regional thickening values were derived. The thickening results were then compared with standard 17-segment 6-point visual scoring of wall motion/wall thickening (0=normal; 5=greatest abnormality) performed by a consensus of two experienced imaging cardiologists. Preliminary results on eight subjects indicated a strong negative correlation (r=-0.8, p<0.0001) between the average thickening obtained using Laplace and the summed segmental visual scores. Additionally, quantitative ejection fraction measurements also correlated well with average thickening scores (r=0.72, p<0.0001). For segmental analysis, we obtained an overall correlation of -0.55 (p<0.0001) with higher agreement along the mid and apical regions (r=-0.6). In conclusion 3D Laplace transform can be used to quantify myocardial thickening in 3D.

Prasad, M.; Ramesh, A.; Kavanagh, P.; Gerlach, J.; Germano, G.; Berman, D. S.; Slomka, P. J.



[Wide esophageal wall rupture as iatrogenic complication of anterior cervical spine surgery].  


The case of 19-year old men with iatrogenic esophageal wall perforation is presented. The patient underwent anterior cervical stabilization using plate and screw for fracture of the C4 and C5 vertebra followed by an abscess of prevertebral space with discharging pus and food from the wound. The general condition was poor. Symptoms included: pneumonia, pleuritis with effusion, septicemia with mediastinitis, fever up to 40 and quadriplegia on neurological examination. During surgical procedure the implant loose but was still fixed into the esophagus causing a large defect in the posterior wall of the hypopharynx and cervical part of esophagus was found. The patient undergone three step surgery with wide drainage of prevertebral abscess, removing of osteosynthetic plate removal and formation of pedicle flap with sterno-cleido-mastoideus muscule. The finnal fourth procedure with using of pediculed infrahyoid flap gave an excellent result. During 160 days hospitalization the pus culture showed growth of the 11 bacterials species (like Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis) and 2 species of fungus. He was treated 13 types of antybiotics. This special case we present because of live threatening complication (mediastinitis) and complicated clinical course as well as because of unique technique of the defect closure, i.e. the infrahyoid flap occurred to be successful. PMID:16521458

Wierzbicka, Ma?gorzata; Pabiszczak, Maciej; Smuszkiewicz, Piotr; Szyfter, Witold



The anterior vaginal wall as an organ for the transmission of active forces to the urethra and the clitoris  

Microsoft Academic Search

Attention is drawn to the fact that the anterior vaginal wall is not a simple mucous membrane but an active organ, with a hammock-like effect on the urethra. It also functions during intercourse to transmit the effect of penile introduction into the vagina to the clitoris, by stretching the two ligaments that insert around its base.

A. Ingelman-Sundberg



A blunt chest trauma causing left anterior descending artery dissection and acute myocardial infarction treated by deferred angioplasty.  


Traumatic coronary artery dissection is an uncommon cause of acute myocardial infarction (AMI). We report a case of blunt chest trauma resulting from a motorcycle collision causing ostial dissection of the left anterior descending (LAD) artery in a 31-year-old previously healthy male. The patient also suffered from compound comminuted fractures of the humerus and ulna and severe liver laceration, which hampered both percutaneous and surgical acute revasularization. After a stormy hospital course, a bare metal stent was implanted to seal the LAD artery dissection. The patient was discharged in a stable condition and was followed-up for rehabilitation. This case report underscores the multidisciplinary approach in facing challenges encountered after rare sequelae of chest trauma. PMID:22121464

Al-Aqeedi, Rafid Fayadh; Ali, Waleed Muhsin; Al-Ani, Fuad; Abdulrahman, Yassir S; Alnabti, Abdulrahman



Finite Element Analysis of Ventricular Wall Motion and Intra-Ventricular Blood Flow in Heart with Myocardial Infarction  

NASA Astrophysics Data System (ADS)

To study the wall motion abnormality and characteristic flow distribution observed in the heart with myocardial infarction, we modified our finite element model of left ventricle and performed simulations at two different phases after the onset of the disease by applying characteristic material property to the infarcted region. The model could not only reproduce the hemodynamic change in myocardial infarction but also give mechanistic insight into the following complicating problems. 1) Stagnation of blood as the cause of clot formation 2) Extra energy wasted for the stretch of infarcted tissue. The effect of compensatory enhancement of the force generation in normal myocardial tissue is also discussed.

Watanabe, Hiroshi; Sugano, Takeshi; Sugiura, Seiryo; Hisada, Toshiaki


Double rupture of interventricular septum and free wall of the left ventricle, as a mechanical complication of acute myocardial infarction: a case report  

Microsoft Academic Search

INTRODUCTION: Cardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Double myocardial rupture is a rare complication of acute myocardial infarction (0.3 %) and the report of such cases is exclusively limited to a small series of autopsy studies. CASE PRESENTATION: In this report we present the unusual case

Elias I Rentoukas; George A Lazaros; Andreas P Kaoukis; Evangellos P Matsakas



Real-time assessment of myocardial perfusion and wall motion during bicycle and treadmill exercise echocardiography: comparison with single photon emission computed tomography  

Microsoft Academic Search

OBJECTIVESWe sought to determine the feasibility and accuracy of real-time imaging of myocardial contrast echocardiography (MCE) in detecting myocardial perfusion defects during exercise echocardiography compared with radionuclide tomography.BACKGROUNDUltrasound imaging at a low mechanical index and frame rate (10 to 20 Hz) after intravenous injections of perfluorocarbon containing microbubbles has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously

Sarah Shimoni; William A Zoghbi; Feng Xie; David Kricsfeld; Sherif Iskander; Lisa Gobar; Issam A Mikati; John Abukhalil; Mario S Verani; Edward L O’Leary; Thomas R Porter



Regional myocardial perfusion and wall thickening during ischemia in conscious dogs.  


We examined in conscious dogs the effects of reductions in myocardial blood flow (MBF) in three different layers across the wall on regional myocardial contractile function in the ischemic zone, measured as systolic wall thickening (%WT). In 16 dogs, %WT was measured with sonomicrometry and MBF was determined with microspheres (10- to 12-microns diam) during coronary stenosis of the left circumflex coronary artery. The stenoses were categorized into six groups by the effect on %WT (each group representing progressive 20% decrements in %WT from control), and individual and pooled regression analyses were performed on data from six of the dogs having multiple data points to evaluate the shape (linear or curvilinear) of the relationships between MBF and changes in %WT. Transmural contractile function was highly sensitive to acute reductions in MBF, especially reductions in the subendocardium. The shape of the normalized subendocardial MBF-%WT relation was mildly curvilinear by regression analysis (quadratic equation, gamma = -0.75x2 + 2.15x -0.39, r2 = 0.92). Likewise, mean transmural and midmyocardial MBF correlated well and closely with changes in %WT. Subepicardial MBF, however, correlated poorly with changes in %WT, there being no change in subepicardial MBF until %WT had been reduced more than 50%. PMID:6496754

Gallagher, K P; Matsuzaki, M; Koziol, J A; Kemper, W S; Ross, J



Assessment of hemodynamic significance of isolated stenoses of the left anterior descending coronary artery using thallium-201 myocardial scintigraphy  

SciTech Connect

This study tests the hypothesis that the results of stress thallium-201 myocardial perfusion scans (TI-201) are related to the mean transstenotic pressure gradient of coronary stenoses independent of the percent luminal diameter narrowing seen at angiography. The 22 study patients (20 men, 2 women, mean age 47 years, range 30 to 62) had no previous myocardial infarction. Each underwent a symptom-limited, erect bicycle TI-201 test off antianginal therapy, shortly before percutaneous transluminal coronary angioplasty for isolated left anterior descending coronary artery stenosis. The percent narrowing, mean gradient at percutaneous transluminal coronary angioplasty and presence of a visually apparent TI-201 defect were independently evaluated and results compared. All 4 patients with 90% or greater diameter narrowing had positive TI-201 responses, and the mean gradient was 72 +/- 11 mm Hg. Among the 18 patients with less than 90% diameter narrowing, the mean gradient was higher (p less than 0.001) in the 11 with a positive TI-201 (63 +/- 15 mm Hg) than in the 7 with a negative TI-201 (33 +/- 20 mm Hg), but their percent narrowing did not differ significantly (72 +/- 14% vs 66 +/- 19%). Multiple regression analysis showed that the presence of a TI-201 defect was a strong (p . 0.003) and percent narrowing (p . 0.048) a weak independent predictor for gradient. When the mean gradient was normalized for the prestenotic pressure, both percent narrowing (p . 0.003) and TI-201 defects (p . 0.006) were significant independent predictors.

Kalff, V.; Kelly, M.J.; Soward, A.; Harper, R.W.; Currie, P.J.; Lim, Y.L.; Pitt, A.



Anatomical description of the deep venous channel from the anterior vestibular wall of the right atrium.  


The deep venous channels in the walls of the right atrium are not routinely described in medical treatises although their existence has been remarked from some time. Our study demonstrates that the right atrium is opened for some of the anterior veins of the heart through a venous channel located deep in the myocardium of the vestibule of the right atrium. We suggest that no Thebesian veins drain into this channel. We achieved anatomical dissection in 14 adult human cadaveric hearts, which had been fixed in formalin solution, and we found the channel in 75% of cases. These channels were measured, photographed and presented in detail. We highlighted the importance of the proximity with the tricuspid annulus in order to avoid incidents during tricuspid annuloplasty. The authors intend that through a qualitative study to draw attention to such a structure often ignored. This vascular structure and its role in cardiac physiology and pathology have not been investigated yet. Although not constant, specialists in cardiology and cardiac surgery should be informed about this basic detail on the endocardium morphology. PMID:24068407

Filipoiu, F M; B?lgr?dean, Mihaela; Brezean, I; Jinga, V



Coronary artery wall thickness of the left anterior descending artery using high resolution transthoracic echocardiography--normal range of values.  


Recently it has been demonstrated that high resolution transthoracic echocardiography (HRTTE) is able to detect differences in the wall thickness of the left anterior descending coronary artery (LAD) between patients with coronary artery disease (CAD) and normal volunteers. We sought to validate this technique, develop a normal range of values and demonstrate the test-retest variability of each measurement. Two hundred forty-two volunteer participants had a HRTTE study to measure their LAD wall thickness, luminal, and external diameters. Thirty of these subjects had these measurements taken on 3 separate occasions by 2 different echosonographers. All subjects were free of clinical CAD, hypertension, hyperlipidemia, and diabetes mellitus. The average anterior wall thickness was 1.1 ± 0.2 mm; posterior wall thickness was 1.1 ± 0.2 mm, luminal diameter 2.2 ± 0.6 mm, and external elastic membrane (EEM) diameter 4.5 ± 0.9 mm. The bias of the measurements within the same operator for LAD wall thickness, luminal diameter, and EEM was 0.042, -0.06, and -0.077 mm, respectively. The bias of the measurements between 2 different operators for LAD wall thickness, luminal diameter, and EEM was 0.082, -0.077, and -0.027 mm, respectively. In conclusion, HRTTE measurement of the LAD vessel is reproducible within and between operators in normal volunteers. This technique therefore warrants further study as a potential screening modality for subclinical coronary atherosclerosis. PMID:23346915

Perry, Rebecca; Joseph, Majo X; Chew, Derek P; Aylward, Philip E; De Pasquale, Carmine G



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

SciTech Connect

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.

McInerney, J.J.; Copenhaver, G.L.; Herr, M.D.; Morris, D.L.; Zelis, R. (Pennsylvania State Univ., Hershey (USA))



Clinical implications of the technetium-99m stannous pyrophosphate myocardial scintigraphic doughnut pattern in patients with acute myocardial infarcts  

Microsoft Academic Search

Forty-five patients with acute myocardial infarcts had technetium-99m stannous pyrophosphate (\\/sup 99m\\/Tc-PYP) myocardial scintigrams with radionuclide uptake localized to the anterior or lateral wall of the left ventricle in a pattern resembling a doughnut (intense peripheral uptake and relatively less central uptake). Sixty-seven percent of these patients developed left ventricular failure with infarction. Twenty-six patients with acute anterior or lateral

R. E. Rude; R. W. Parkey; F. J. Bonte; S. E. Lewis; D. Twieg; L. M. Buja; J. T. Willerson



Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress  

PubMed Central

Background Dobutamine stress cardiovascular magnetic resonance (DS-CMR) is an established tool to assess hibernating myocardium and ischemia. Analysis is typically based on visual assessment with considerable operator dependency. CMR myocardial feature tracking (CMR-FT) is a recently introduced technique for tissue voxel motion tracking on standard steady-state free precession (SSFP) images to derive circumferential and radial myocardial mechanics. We sought to determine the feasibility and reproducibility of CMR-FT for quantitative wall motion assessment during intermediate dose DS-CMR. Methods 10 healthy subjects were studied at 1.5 Tesla. Myocardial strain parameters were derived from SSFP cine images using dedicated CMR-FT software (Diogenes MRI prototype; Tomtec; Germany). Right ventricular (RV) and left ventricular (LV) longitudinal strain (EllRV and EllLV) and LV long-axis radial strain (ErrLAX) were derived from a 4-chamber view at rest. LV short-axis circumferential strain (EccSAX) and ErrSAX; LV ejection fraction (EF) and volumes were analyzed at rest and during dobutamine stress (10 and 20 ?g · kg-1· min-1). Results In all volunteers strain parameters could be derived from the SSFP images at rest and stress. EccSAX values showed significantly increased contraction with DSMR (rest: -24.1 ± 6.7; 10 ?g: -32.7 ± 11.4; 20 ?g: -39.2 ± 15.2; p < 0.05). ErrSAX increased significantly with dobutamine (rest: 19.6 ± 14.6; 10 ?g: 31.8 ± 20.9; 20 ?g: 42.4 ± 25.5; p < 0.05). In parallel with these changes; EF increased significantly with dobutamine (rest: 56.9 ± 4.4%; 10 ?g: 70.7 ± 8.1; 20 ?g: 76.8 ± 4.6; p < 0.05). Observer variability was best for LV circumferential strain (EccSAX ) and worst for RV longitudinal strain (EllRV) as determined by 95% confidence intervals of the difference. Conclusions CMR-FT reliably detects quantitative wall motion and strain derived from SSFP cine imaging that corresponds to inotropic stimulation. The current implementation may need improvement to reduce observer-induced variance. Within a given CMR lab; this novel technique holds promise of easy and fast quantification of wall mechanics and strain.



Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction  

Microsoft Academic Search

To study the value of the electrocardiogram in diagnosing right ventricular involvement in acute inferior wall myocardial infarction, the electrocardiographic findings were analysed in 67 patients who had had scintigraphy to pin-point the infarct. All 67 patients were consecutively admitted because of an acute inferior wall infarction. A 12 lead electrocardiogram with four additional right precordial leads (V3R, V4R, V5R,

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



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

Microsoft Academic Search

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

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



A prospective comparison of echocardiographic wall motion score index and radionuclide ejection fraction in predicting outcome following acute myocardial infarction  

Microsoft Academic Search

OBJECTIVETo characterise echocardiographic wall motion score index (WMSI) as a surrogate measure of left ventricular ejection fraction (EF) following acute myocardial infarction (AMI) and to compare its prognostic value with that of EF measured by radionuclide ventriculography (RNV).DESIGNA prospective study to compare baseline echocardiographic WMSI with RNV EF in consecutive patients thrombolysed for AMI, both performed on the same day

G I W Galasko; S Basu; A Lahiri; R Senior



New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction  

Microsoft Academic Search

In patients with inferior wall acute myocardial infarction (AMI), the site of the culprit lesion is an important determinant of outcome. Patients with right ventricular infarction have a poor prognosis, whereas those with occlusion of the left circumflex coronary artery (LCx) have a good prognosis. Therefore, we assessed whether standard 12-lead electrocardiograms obtained on admission could identify the site of

Masami Kosuge; Kazuo Kimura; Toshiyuki Ishikawa; Yoichiro Hongo; Yasuyuki Mochida; Mitsugi Sugiyama; Osamu Tochikubo



A 3-D Finite Element Model of Anterior Vaginal Wall Support to Evaluate Mechanisms Underlying Cystocele Formation  

PubMed Central

Objectives To develop a 3D computer model of the anterior vaginal wall and its supports, validate that model, and then use it to determine the combinations of muscle and connective tissue impairments that result in cystocele formation, as observed on dynamic magnetic resonance imaging (MRI). Methods A subject-specific 3D model of the anterior vaginal wall and its supports was developed based on MRI geometry from a healthy nulliparous woman. It included simplified representations of the anterior vaginal wall, levator muscle, cardinal and uterosacral ligaments, arcus tendineus fascia pelvis and levator ani, paravaginal attachments, and the posterior compartment. This model was then imported into ABAQUS™ and tissue properties were assigned from the literature. An iterative process was used to refine anatomical assumptions until convergence was obtained between model behavior under increases of abdominal pressure up to 168 cmH2O and deformations observed on dynamic MRI. Results Cystocele size was sensitive to abdominal pressure and impairment of connective tissue and muscle. Larger cystocele formed in the presence of impairments in muscular and apical connective tissue support compared to either support element alone. Apical impairment resulted in a larger cystocele than paravaginal impairment. Levator ani muscle impairment caused a larger urogenital hiatus size, longer length of the distal vagina exposed to a pressure differential, larger apical descent and resulted in a larger cystocele size. Conclusions Development of a cystocele requires a levator muscle impairment, an increase in abdominal pressure, and apical and paravaginal support defects.

Chen, Luyun; Ashton-Miller, James A.; DeLancey, John O.L.



Non-invasive evaluation of myocardial reperfusion by transthoracic Doppler echocardiography and single-photon emission computed tomography in patients with anterior acute myocardial infarction  

PubMed Central

Background The study was designed to evaluate whether the preserved coronary flow reserve (CFR) 72 hours after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction and is predictive of left ventricular (LV) functional recovery and the final infarct size at follow-up. Methods In our study, CFR was assessed by transthoracic Doppler echocardiography (TDE) in 44 patients after the successful percutaneous coronary intervention during the acute AMI phase. CFR was correlated with contractile reserve assessed by low-dose dobutamine echocardiography and with the total perfusion defect measured by single-photon emission computed tomography 72 hours after reperfusion and at 5 months follow-up. The ROC analysis was performed to determine test sensitivity and specificity based on CFR. Categorical data were compared by an ?2 analysis, continuous variables were analysed with the independent Student's t test. In order to analyse correlation between CFR and the parameters of LV function and perfusion, the Pearson correlation analysis was conducted. The linear regression analysis was used to assess the relationship between CFR and myocardial contractility as well as the final infarct size. Results We estimated the CFR cut-off value of 1.75 as providing the maximal accuracy to distinguish between patients with preserved and impaired CFR during the acute AMI phase (sensitivity 91.7%, specificity 75%). Wall motion score index was better in the subgroup with preserved CFR as compared to the subgroup with reduced CFR: 1.74 (0.29) vs. 1.89 (0.17) (p < 0.001) during the acute phase and 1.47 (0.30) vs. 1.81 (0.20) (p < 0.001) at follow-up, respectively. LV ejection fraction was 47.78% (8.99) in preserved CFR group vs. 40.79% (7.25) in impaired CFR group (p = 0.007) 72 hours after reperfusion and 49.78% (8.70) vs. 40.36% (7.90) (p = 0.001) after 5 months at follow-up, respectively. The final infarct size was smaller in patients with preserved as compared to patients with reduced CFR: 5.26% (6.14) vs. 23.28% (12.19) (p < 0.001) at follow-up. Conclusion The early measurement of CFR by TDE can be of high value for the assessment of successful reperfusion in AMI and can be used to predict LV functional recovery, myocardial viability and the final infarct size.



Heterogeneity of myocardial fatty acid tracer uptake in the porcine heart wall  

NASA Astrophysics Data System (ADS)

Spatial heterogeneity of myocardial perfusion has been recognized for many years. We have previously shown that whole-body CT is a method for providing the simultaneous measurements of heterogeneity of myocardial perfusion and myocardial blood volume. In the present study we found that the spatial distribution of myocardial metabolism, as indicated by the local accumulation of iodinated phenyl pentadecanoic acid, is slightly more heterogeneous than, but not statistically different from, the heterogeneity of perfusion and blood volume. These findings are consistent with the notion that a common factor is likely to play a major role in determining the spatial heterogeneity of myocardial intravascular blood volume, of myocardial perfusion and of myocardial metabolism.

Ritman, Erik L.; Beighley, Patricia E.



Effect of intraaortic balloon counter-pulsation on QT dispersion in acute anterior myocardial infarction.  


The present prospective non-randomized study aimed to examine whether intraaortic balloon counter-pulsation (IABP) has a favorable effect on QT dispersion in patients with acute anterior MI. Patients with acute anterior MI who presented within 6 h after the symptom onset were assigned to the IABP + streptokinase or streptokinase (STK) group. The IABP + STK group was consisted of 26 men and two women (mean age 52.9+/-10.2). The STK group was consisted of 19 men and two women (mean age 54.4+/-10.8). In the IABP + STK group, mean QT interval dispersion significantly shortened 6 h after treatment (50.9+/-15.6 ms before STK, and 36+/-13.9 ms 6 h after STK; P = 0.001) and did not significantly change 24 h after STK (35.6+/-11.2 ms). In the STK group, mean QT interval dispersion did not vary significantly before and 6 h after STK (57.14+/-13.2 ms before STK, and 56.07+/-13.3 ms 6 h after STK; P > 0.05) but 24 h after STK it significantly shortened to 40.42+/-10.8 ms (P < 0.001). Before STK, mean QT interval dispersions in the IABP + STK and STK groups were 50.9+/-15.6 ms and 57.14+/-13.2 ms, respectively (P > 0.05), 6 h after STK, mean QT interval dispersions were 36+/-13.9 ms and 56.07+/-13.3 ms, respectively (P = 0.0001) and 24 h after STK, mean QT interval dispersions were 35.6+/-11.2 ms and 40.42+/-10.8 ms, respectively (P > 0.05). In conclusion this study demonstrates that the adjunct of IABP to thrombolytic therapy, in the setting of acute anterior MI, significantly decreases QT interval dispersion at 6 h and this effect might be secondary to accelerated reperfusion and/or other beneficial effects of IABP. PMID:9706812

Kumbasar, S D; Semiz, E; Ermis, C; Yalçinkaya, S; Deger, N; Pamir, G; Oral, D



Experimental myocardial infarction  

PubMed Central

The hemodynamic effects of tachycardia induced by atrial pacing were investigated in left ventricular failure of acute and healing experimental myocardial infarction in 20 intact, conscious dogs. Myocardial infarction was produced by gradual inflation of a balloon cuff device implanted around the left anterior descending coronary artery 10-15 days prior to the study. 1 hr after acute myocardial infarction, atrial pacing at a rate of 180 beats/min decreased left ventricular end-diastolic pressure from 19 to 8 mm Hg and left atrial pressure from 17 to 12 mm Hg, without change in cardiac output. In the healing phase of myocardial infarction 1 wk later, atrial pacing decreased left ventricular end-diastolic pressure from 17 to 9 mm Hg and increased the cardiac output by 37%. This was accompanied by evidence of peripheral vasodilation. In two dogs with healing anterior wall myocardial infarction, left ventricular failure was enhanced by partial occlusion of the circumflex coronary artery. Both the dogs developed pulmonary edema. Pacing improved left ventricular performance and relieved pulmonary edema in both animals. In six animals propranolol was given after acute infarction, and left ventricular function deteriorated further. However the pacing-induced augmentation of cardiac function was unaltered and, hence, is not mediated by sympathetics. The results show that the spontaneous heart rate in left ventricular failure of experimental canine myocardial infarction may be less than optimal and that maximal cardiac function may be achieved at higher heart rates. Images

Kumar, Raj; Joison, Julio; Gilmour, David P.; Molokhia, Farouk A.; Pegg, C. A. S.; Hood, William B.



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

SciTech Connect

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.

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



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

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.

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



Report of three cases of unusual anterior abdominal wall defects in fallujah general hospital during the year 2010.  


Abdominal wall defects occur when the normal sequence of the gastro intestinal tract development is interrupted. Gastroschisis represents a herniation of abdominal contents through a paramedian full-thickness abdominal wall fusion defect without involving the umbilical cord. Evisceration usually only contains intestinal loops and has no surrounding membrane unlike omphalocoele. It is unusual for a newborn with gastroschisis to have other serious birth defects. Neonates with gastroschisis have better prognosis than those with omphalocele. Very rarely is gastroschisis associated with herniation of other organs, and their presence makes the prognosis worse. I report three cases of unusual anterior abdominal wall defects during the year 2010, each having specific associated abnormalities. One was stillborn, and the other two died shortly after delivery. PMID:23864990

Alaani, Samira



Report of Three Cases of Unusual Anterior Abdominal Wall Defects in Fallujah General Hospital During the Year 2010  

PubMed Central

Abdominal wall defects occur when the normal sequence of the gastro intestinal tract development is interrupted. Gastroschisis represents a herniation of abdominal contents through a paramedian full-thickness abdominal wall fusion defect without involving the umbilical cord. Evisceration usually only contains intestinal loops and has no surrounding membrane unlike omphalocoele. It is unusual for a newborn with gastroschisis to have other serious birth defects. Neonates with gastroschisis have better prognosis than those with omphalocele. Very rarely is gastroschisis associated with herniation of other organs, and their presence makes the prognosis worse. I report three cases of unusual anterior abdominal wall defects during the year 2010, each having specific associated abnormalities. One was stillborn, and the other two died shortly after delivery.

Alaani, Samira



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

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.

Juilliere, Y.; Marie, P.Y.; Danchin, N.; Karcher, G.; Bertrand, A.; Cherrier, F. (CHU Nancy-Brabois, Vandoeuvre-les-Nancy (France))



Impact of Serum C-Reactive Protein Elevation on the Left Ventricular Spherical Change and the Development of Mitral Regurgitation after Anterior Acute Myocardial Infarction  

Microsoft Academic Search

Background\\/Aims: Mitral regurgitation (MR) is frequently observed in patients with acute myocardial infarction (AMI), and is known to convey an adverse prognosis. We sought to clarify the relationship between MR and left ventricular (LV) remodeling, in association with serum C-reactive protein (CRP) elevation. Methods\\/Results: A total of 181 patients with first anterior ST-elevation AMI were examined. MR was detected in

Takashi Kohno; Toshihisa Anzai; Kotaro Naito; Yohei Ohno; Hidehiro Kaneko; Hui-Chong Li; Yasuo Sugano; Yuichiro Maekawa; Shiro Iwanaga; Yasushi Asakura; Tsutomu Yoshikawa; Satoshi Ogawa



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

SciTech Connect

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.

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. (Univ. of Chicago Pritzker School of Medicine, IL (USA))



Segmental wall-motion analysis in the right anterior oblique projection: comparison of exercise equilibrium radionuclide ventriculography and exercise contrast ventriculography  

Microsoft Academic Search

Thirty-nine patients with known or suspected coronary artery disease were studied at rest and during supine bicycle exercise with radionuclide and contrast left ventriculography. Analysis of regional wall motion was made by visual evaluation of the five standard 30° right anterior oblique (RAO) wall segments in the contrast images and the corresponding 10° RAO radionuclide segments. The radionuclide studies were

T. J. Brady; J. H. Thrall; J. W. Jr. Keyes; J. F. Brymer; J. A. Walton; B. Pitt



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

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).

Renkin, J.; Wijns, W.; Ladha, Z.; Col, J. (Univ. of Louvain Medical School, Brussels (Belgium))



What makes a coronary myocardial bridge symptomatic?  


The clinical significance of coronary myocardial bridging has been debated and different interventional strategies proposed. We discuss the case of a patient who presented with the recent onset of symptoms of exertional chest pain, diaphoresis, and electrocardiographic signs of acute anterior myocardial wall ischemia. Cardiac catheterization demonstrated a segmental high-grade narrowing of the mid left anterior descending coronary artery during systole consistent with bridging. Intravenous fluid resuscitation and calcium channel blockade resulted in normalization of his electrocardiogram and complete resolution of his anginal symptoms and coronary angiographic systolic narrowing. PMID:9835740

Podbielski, F J; el Chaer, R; Massad, M G; Chami, Y G; Nawas, S; O'Leary, P; Benedetti, E



Extensive anterior chest wall ecchymosis as a sign of subacute type A aortic dissection.  


A 66-year old man was admitted to the hospital with chest and back pain and wide chest wall ecchymosis. His medical history revealed no chest trauma or resuscitation, but coronary angiography had been performed 20 days previously. Subacute type A aortic dissection was diagnosed. The likely cause of an ecchymosis located in this way, correlated with vasculature of thoracic wall, was thought to be progression of the dissection through the arterial branches feeding the chest wall. Perioperative observation confirmed the diagnosis and a hemiarch replacement was performed with a good outcome. PMID:22791789

Yazici, Pinar; Oz, Kursad; Celik, Omer; Erek, Ersin



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

SciTech Connect

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.

Kubota, I.; Yamaki, M.; Ikeda, K.; Yamaguchi, I.; Tonooka, I.; Tsuiki, K.; Yasui, S. (Yamagata Univ. School of Medicine (Japan))



Myocardial dysfunction in the periinfarct and remote regions following anterior infarction in rats quantified by 2D radial strain echocardiography: An observational cohort study  

PubMed Central

Background Heart failure from adverse ventricular remodeling follows myocardial infarction, but the contribution of periinfarct and remote myocardium to the development of cardiomyopathy remains poorly defined. 2D strain echocardiography (2DSE) is a novel and sensitive tool to measure regional myocardial mechanics. The aim is to quantify radial strain in infarcted (I), periinfarct (PI) and remote (R) myocardial regions acutely and chronically following anterior infarction in rats. Methods The left anterior coronary artery of male Sprague-Dawley rats (270–370 g) were occluded for 20–30 minutes and 2DSE was performed in the acute setting (n = 10; baseline and 60 minutes post-reperfusion) and in the chronic setting (n = 14; baseline, 1, 3 and 6 weeks). Using software, radial strain was measured in the mid-ventricle in short axis view. The ventricle was divided into 3 regions: I (anteroseptum, anterior and anterolateral), PI – (inferoseptum and inferolateral) and R – (inferior). Infarct size was measured using triphenyl tetrazolium chloride in the acute group. Results Following infarct, adverse remodeling occurred with progressive increase in left ventricular size, mass and reduced fractional shortening within 6 weeks. Radial strain decreased not only in the infarct but also in the periinfarct and remote regions acutely and chronically (I, PI, R, change vs. baseline, 60 minutes -32.7 ± 8.7, -17.4 ± 9.4, -13.5 ± 11.6%; 6 weeks -24.4 ± 8.2, -17.7 ± 8.3, -15.2 ± 8.4% respectively, all p < 0.05). Reduced radial strain in periinfarct and remote regions occurred despite minimal or absent necrosis (area of necrosis I, PI, R: 48.8 ± 23, 5.1 ± 6.6, 0 ± 0%, p < 0.001 vs. I). Conclusion Following left anterior coronary occlusion, radial strain decreased at 60 minutes and up to 6 weeks in the periinfarct and remote regions, similar to the reduction in the infarct region. This demonstrates early and chronic myopathic process in periinfarct and remote regions following myocardial infarction that may be an under recognized but important contributor to adverse left ventricular remodeling and progression to ischemic cardiomyopathy.

Migrino, Raymond Q; Zhu, Xiaoguang; Morker, Mineshkumar; Brahmbhatt, Tejas; Bright, Megan; Zhao, Ming



Surgical management of left ventricular free wall rupture after acute myocardial infarction  

Microsoft Academic Search

Left ventricular rupture after acute myocardial infarction occurs more often than suspected and diagnosis is rarely made before death. Left ventricular rupture has been reported to contribute to the overall in-hospital mortality after acute myocardial infarction in up to 24% of cases and to be present in 40% of patients dying within the first week after infarction. Only prompt diagnosis

G. Coletti; L. Torracca; M. Zogno; G. La Canna; R. Lorusso; A. Pardini; O. Alfieri



Evaluation of myocardial viability with myocardial contrast echocardiography: a preliminary clinical study.  


OBJECTIVE: To evaluate the efficacy of myocardial contrast echocardiography (MCE) in the assessment of myocardial viability, with positron emission tomography (PET) as the golden standard. METHODS: Eleven patients with anterior wall Q wave myocardial infarction were enrolled in this study, who received successful percutaneous transluminal coronary angioplasty (PTCA) 3 to 19 months prior to the examinations by PET and MCE that were completed within 2 d. RESULTS: MCE score for the segments of necrotic myocardium, viable myocardium and normal myocardium was mostly 0, 0.5 and 1 respectively, and there was a significant difference between the grades of MCE score in identifying myocardial viability. In terms of diagnosing myocardium survival, MCE result was closely correlated with that of PET (with the correlation index rp of 0.78). CONCLUSION: Myocardial perfusion evaluation can be effectively accomplished by MCE, which might serve as a new approach to assess myocardial viability in clinical practice. PMID:12426173

Zhang, Wen-Zhu; Zha, Dao-Gang; Bin, Jian-Ping; Liu, Jian; Wang, Peng; Wu, Hu-Bing; Huang, Zu-Han; Zhou, Zhong-Jiang; Li, Qi; Liu, Yi-Li



Neurophysiological evaluation of convergent afferents innervating the human esophagus and area of referred pain on the anterior chest wall.  


Noxious stimuli in the esophagus cause pain that is referred to the anterior chest wall because of convergence of visceral and somatic afferents within the spinal cord. We sought to characterize the neurophysiological responses of these convergent spinal pain pathways in humans by studying 12 healthy subjects over three visits (V1, V2, and V3). Esophageal pain thresholds (Eso-PT) were assessed by electrical stimulation and anterior chest wall pain thresholds (ACW-PT) by use of a contact heat thermode. Esophageal evoked potentials (EEP) were recorded from the vertex following 200 electrical stimuli, and anterior chest wall evoked potentials (ACWEP) were recorded following 40 heat pulses. The fear of pain questionnaire (FPQ) was administered on V1. Statistical data are shown as point estimates of difference +/- 95% confidence interval. Pain thresholds increased between V1 and V3 [Eso-PT: V1-V3 = -17.9 mA (-27.9, -7.9) P < 0.001; ACW-PT: V1-V3 = -3.38 degrees C (-5.33, -1.42) P = 0.001]. The morphology of cortical responses from both sites was consistent and equivalent [P1, N1, P2, N2 complex, where P1 and P2 are is the first and second positive (downward) components of the CEP waveform, respectively, and N1 and N2 are the first and second negative (upward) components, respectively], indicating activation of similar cortical networks. For EEP, N1 and P2 latencies decreased between V1 and V3 [N1: V1-V3 = 13.7 (1.8, 25.4) P = 0.02; P2: V1-V3 = 32.5 (11.7, 53.2) P = 0.003], whereas amplitudes did not differ. For ACWEP, P2 latency increased between V1 and V3 [-35.9 (-60, -11.8) P = 0.005] and amplitudes decreased [P1-N1: V1-V3 = 5.4 (2.4, 8.4) P = 0.01; P2-N2: 6.8 (3.4, 10.3) P < 0.001]. The mean P1 latency of EEP over three visits was 126.6 ms and that of ACWEP was 101.6 ms, reflecting afferent transmission via Adelta fibers. There was a significant negative correlation between FPQ scores and Eso-PT on V1 (r = -0.57, P = 0.05). These data provide the first neurophysiological evidence of convergent esophageal and somatic pain pathways in humans. PMID:20023227

Hobson, Anthony R; Chizh, Boris; Hicks, Kirsty; Aziz, Qasim; Worthen, Sian; Lawrence, Philip; Dewit, Odile; Boyle, Yvonne; Dukes, George



Reasons for the lack of benefit of immediate angioplasty during recombinant tissue plasminogen activator therapy for acute myocardial infarction: a regional wall motion analysis  

Microsoft Academic Search

Regional ventricular wall motion analysis utilizing three different methods was performed on predischarge left ventriculograms from 291 of 367 patients enrolled in a randomized trial of single chain recombinant tissue-type plasminogen activator (rt-PA), aspirin and heparin with and without immediate angioplasty in patients with acute myocardial infarction. With univariate analysis, no difference in regional wall motion variables between the two

P. W. J. C. Serruys; W. R. Rutsch; M. L. Simoons; Bono de D. P; J. G. P. Tijssen; J. Lubsen; M. Verstraete; A. E. R. Arnold



Internal herniation of the anterior gastric wall through an attenuated Nissen Fundoplication wrap: an unusual complication and its laparoscopic management.  


Laparoscopic Nissen fundoplication is the treatment of choice for medically refractive gastro-oesophageal reflux disease as it is considered safe, cost efficient and effective. Unusual variants of internal abdominal herniation, however, have been reported after the procedure. Here, we present a case of a 38-year-old woman who presented 3 months after a successful laparoscopic Nissen Rossetti fundoplication, with abdominal pain and persistent vomiting. Abdominal X-ray at the time of admission was normal but CT suggested internal herniation of the stomach. Laparoscopy confirmed internal herniation of the anterior wall of the stomach through an attenuated fundoplication wrap. We show that a prompt diagnosis of this complication, which we have not found reported previously in the English literature, can be achieved by CT, permitting an early laparoscopic intervention to preserve the viability of the obstructed segment of stomach. PMID:20694799

Chattopadhyay, D; Wynne, K S



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

PubMed Central

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.

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



LeftStellectomy inthePrevention ofVentricular Fibrillation Caused byAcuteMyocardial Ischemia inConscious DogswithAnterior Myocardial Infarction  

Microsoft Academic Search

SUMMARY Thepotential ofleft stellectomy inreducing theincidence ofventricular fibrillation associated with acutemyocardial ischemia was investigated ina new animal modelforsudden death. Thirty-two dogshad ananterior myocardial infarction produced byligation oftheleft descending coronaryartery. Oneweeklater they wererandomly allocated toa control ortoanexperimental groupthatunderwent left stellectomy. One monthafter ligation while thedogswereconscious, a balloon occluder previously positioned aroundthecir- cumflex coronaryartery wasinflated andtheensuing coronaryocclusion wasmaintained for10minutes. Ven- tricular fibrillation



Survival after Left Ventricular Free Wall Rupture in an Elderly Woman with Acute Myocardial Infarction Treated Only Medically  

PubMed Central

Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.

Roa-Castro, Victor Hugo; Molina-Bello, Ervin; Valenzuela-Suarez, Hector; Rotberg-Jagode, Tobias; Espinola-Zavaleta, Nilda



Left ventricular thrombosis and cerebrovascular accident in acute myocardial infarction  

Microsoft Academic Search

In a prospective study of 90 consecutive patients with acute myocardial infarction, 15 (28.3%) of 53 patients with an anterior wall infarction developed a left ventricular thrombosis diagnosed by cross sectional echocardiography. Patients received anticoagulants only after a left ventricular thrombosis had been diagnosed. Twenty eight patients had an inferior infarction, but none of these had a left ventricular thrombosis.

K A Johannessen; J E Nordrehaug; G von der Lippe



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

SciTech Connect

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).

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



Diagnostic accuracy of supine and prone thallium-201 stress myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in inferior wall of left ventricle  

Microsoft Academic Search

Objective  Prone thallium-201 (201Tl) myocardial perfusion single-photon emission computed tomography (SPECT) reduces false-positive rates when evaluating inferior\\u000a wall abnormalities by minimizing diaphragmatic attenuation. The present study investigates the diagnostic validity of prone\\u000a 201Tl stress myocardial perfusion SPECT for detecting coronary artery disease in the inferior wall of the left ventricle in Japanese\\u000a patients.\\u000a \\u000a \\u000a \\u000a Methods  Of the 104 consecutive patients who underwent 201Tl

Takuji Katayama; Nobuhiko Ogata; Yoshio Tsuruya



Non-invasive evaluation of myocardial reperfusion by transthoracic Doppler echocardiography and single-photon emission computed tomography in patients with anterior acute myocardial infarction  

Microsoft Academic Search

Background  The study was designed to evaluate whether the preserved coronary flow reserve (CFR) 72 hours after reperfused acute myocardial\\u000a infarction (AMI) is associated with less microvascular dysfunction and is predictive of left ventricular (LV) functional recovery\\u000a and the final infarct size at follow-up.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In our study, CFR was assessed by transthoracic Doppler echocardiography (TDE) in 44 patients after the successful

Egle Sadauskiene; Diana Zakarkaite; Ligita Ryliskyte; Jelena Celutkiene; Alfredas Rudys; Sigita Aidietiene; Aleksandras Laucevicius



MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction  

PubMed Central

Background After anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel. Patients and methods In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery. Results At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003). Conclusions Enhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma.

Rupreht, Mitja; Vogrin, Matjaz; Hussein, Mohsen



Hypopharyngeal Wall Exposure within the Surgical Field : The Role of Axial Rotation of the Thyroid Cartilage during Anterior Cervical Surgery  

PubMed Central

Objective Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH). Methods The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels. Results The angle of ARTC ranged from -6.9° to 29.7°, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC. Conclusion Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage.

Choi, Byung Kwan; Cho, Won Ho; Choi, Chang Hwa; Song, Geun Sung; Kim, Choongrak



Double rupture of interventricular septum and free wall of the left ventricle, as a mechanical complication of acute myocardial infarction: a case report  

PubMed Central

Introduction Cardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Double myocardial rupture is a rare complication of acute myocardial infarction (0.3 %) and the report of such cases is exclusively limited to a small series of autopsy studies. Case presentation In this report we present the unusual case of a 70-year-old woman with acute anteroseptal myocardial infarction, which was complicated by a combined rupture of the interventricular septum near the apex, and the free wall of the left ventricle with concomitant formation of a pseudoaneurysm. The double myocardial rupture was accidentally discovered 10 days later with echocardiography, when the patient, complaining only of mild exertional dyspnea, was hospitalized for a scheduled coronary angiography. The patient underwent successful surgical correction of the double myocardial rupture along with by-pass grafting. Conclusion This report highlights the importance of comprehensive noninvasive predischarge diagnostic evaluation of all postinfarct patients, since serious and potentially life-threatening complications might have not been suspected on clinical grounds.

Rentoukas, Elias I; Lazaros, George A; Kaoukis, Andreas P; Matsakas, Evangellos P



Effect of decreased blood flow and ischemia on myocardial thallium clearance  

SciTech Connect

To determine the effect of reduced coronary blood flow on myocardial thallium-201 clearance over a range of flows, miniature radiation detectors were inserted into the left ventricular apex and positioned against the anterior and posterior endocardial walls in 21 dogs. Thallium was administered intravenously and myocardial tracer activity was monitored continuously for 1 hour in both walls. A balloon occluder was then partially inflated around the left anterior descending coronary artery in 19 dogs, producing a range of anterior wall blood flow reductions as assessed by the microsphere technique. Thallium activity was monitored continuously for 3 hours in both walls. Two dogs served as control animals and had no coronary artery occlusion at 1 hour. At the end of the 4 hour experiment, the dogs were sacrificed and the hearts counted in a well counter. The 19 dogs with coronary artery stenosis were divided into three groups (mild, moderate and severe flow reduction groups) on the basis of their poststenosis anterior/posterior wall regional myocardial blood flow ratios. The two control dogs had similar thallium clearances in the anterior and posterior left ventricular walls during the 3 hour period, as assessed by the radiation detectors, and by a final anterior/posterior wall thallium ratio near unity. All three groups of dogs with coronary stenosis had comparable fractional thallium clearances from the anterior and posterior walls before and after the balloon occluder inflation. The final anterior/posterior left ventricular wall thallium ratios were not significantly different than unity for all three groups of dogs.

Okada, R.D.; Pohost, G.M.



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

SciTech Connect

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.

Rich, M.W.; Imburgia, M.; King, T.R.; Fischer, K.C.; Kovach, K.L. (Jewish Hospital Washington University Medical Center, St. Louis (USA))



Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving  

Microsoft Academic Search

Left ventricular free wall rupture (LVFWR) is a fearful complication of acute myocardial infarction in which a swift diagnosis and emergency surgery can be crucial for successful treatment. Because a significant number of cases occur subacutely, clinicians should be aware of the risk factors, clinical features and diagnostic criteria of this complication. We report the case of a 69 year-old

Luís Raposo; Maria João Andrade; Jorge Ferreira; Carlos Aguiar; Rute Couto; Miguel Abecasis; Nuno Jalles-Tavares; José Aniceto da Silva



Spontaneous coronary artery dissection presenting as acute myocardial infarction.  

PubMed Central

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

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



Right ventricular ejection fraction in patients with acute anterior and inferior myocardial infarction assessed by radionuclide angiography  

Microsoft Academic Search

We measured right and left ventricular ejection fraction (EF) from high frequency time-activity curves obtained during the initial passage of an intravenous bolus of \\/sup 99m\\/Tc (Sn) pyrophosphate. In 22 normal controls right ventricular EF averaged 0.52 +- 0.04 (SD). In 24 acute anterior or lateral infarction patients right ventricular EF was normal (0.56 +- 0.10), while left ventricular EF

E. Tobinick; H. R. Schelbert; H. Henning; M. LeWinter; A. Taylor; W. L. Ashburn; J. S. Karliner



The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up.  


Introduction and Hypothesis: We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) Materials and Methods: After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Results: Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. Conclusions: The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts. PMID:24054379

Mahdy, Ayman; Karp, Deborah; Davila, G Willy; Ghoniem, Gamal M


How do hypertrophic cardiomyopathy mutations affect myocardial function in carriers with normal wall thickness? Assessment with cardiovascular magnetic resonance  

PubMed Central

Background Clinical data on myocardial function in HCM mutation carriers (carriers) is sparse but suggests that subtle functional abnormalities can be measured with tissue Doppler imaging before the development of overt hypertrophy. We aimed to confirm the presence of functional abnormalities using cardiovascular magnetic resonance (CMR), and to investigate if sensitive functional assessment could be employed to identify carriers. Results 28 carriers and 28 controls were studied. Global left atrial (LA) and left ventricular (LV) dimensions, segmental peak systolic circumferential strain (SCS) and peak diastolic circumferential strain rate (DCSR), as well as the presence of late Gadolinium enhancement (LGE) were determined with CMR. Septal and lateral myocardial velocities were measured with echocardiographic tissue Doppler imaging. lv mass and volumes were comparable between groups. Maximal septal to lateral wall thickness ratio (SL ratio) was larger in carriers than in controls (1.3 ± 0.2 versus 1.1 ± 0.1, p < 0.001). Also, LA volumes were larger in carriers compared to controls (p < 0.05). Both peak SCS (p < 0.05) and peak DCSR (p < 0.01) were lower in carriers compared to controls, particularly in the basal lateral wall. Focal LGE was present in 2 carriers and not in controls. The combination of a SL ratio >1.2 and a peak DCSR <105%.s-1 was present in 45% of carriers and in none of the controls, yielding a positive predictive value of 100%. Two carriers and 18 controls had a SL ratio < 1.2 and peak DCSR >105%.s-1, yielding a negative predictive value of 90%. With multivariate analysis, HCM mutation carriership was an independent determinant of reduced peak SCS and peak DCSR. Conclusions HCM mutation carriership is an independent determinant of reduced peak SCS and peak DCSR when LV wall thickness is within normal limits, and is associated with increased LA volumes and SL ratio. Using SL ratio and peak DCSR has a high accuracy to identify carriers. However, since carriers also display structural abnormalities and focal LGE, we advocate to also evaluate morphology and presence of LGE when screening for carriers.



Randomized Trial of Low Molecular Weight Heparin (Dalteparin) in Prevention of Left Ventricular Thrombus Formation and Arterial Embolism After Acute Anterior Myocardial Infarction: The Fragmin in Acute Myocardial Infarction (FRAMI) Study 1 1 This study was supported by grants from the Norwegian Council on Cardiovascular Diseases, Oslo, Norway and Pharmacia AB, Stockholm, Sweden  

Microsoft Academic Search

Objectives. The present trial investigated the efficacy and safety of dalteparin in the prevention of arterial thromboembolism after an acute anterior myocardial infarction (MI).Background. Left ventricular (LV) thrombus formation is associated with increased risk of arterial embolism in patients with an acute MI. Thrombolytic and antiplatelet therapy do not prevent thrombus formation.Methods. A total of 776 patients were enrolled in

Frederic Kontny; Jon Dale; Ulrich Abildgaard; Terje R. Pedersen



Evaluation of left ventricular wall motion, volumes, and ejection fraction by gated myocardial tomography with technetium 99m-labeled tetrofosmin: A comparison with cine magnetic resonance imaging  

Microsoft Academic Search

Background  Whether left ventricular function can be assessed accurately by gated single photon emission computed tomography (SPECT) in\\u000a patients with myocardial infarction and severe perfusion defects is not well known.\\u000a \\u000a \\u000a \\u000a Methods and Results  Twenty-five patients with an acute myocardial infarction underwent 99mTc-labeled tetrofosmin (99mTc-tetrofosmin) gated SPECT and cine magnetic resonance imaging (MRI). Wall motion was assessed in 13 left ventricular segments\\u000a using

Periyanan Vaduganathan; Zuo-Xiang He; G. Wesley Vick III; John J. Mahmarian; Mario S. Verani



Clinical evaluation of emission tomography using seven-pinhole collimator: improved detection of perfusion defect by the addition of the right anterior oblique projection  

SciTech Connect

The clinical efficacy of thallium emission myocardial tomography using a seven-pinhole collimator in the right anterior oblique (RAO) projection was evaluated. Myocardial tomography in left anterior oblique (LAO) and RAO projections was performed following planar thallium perfusion imaging at rest in 11 patients with myocardial infarction. The RAO tomogram was useful, especially in detecting apical perfusion defects, while the LAO tomogram was useful in detecting inferior and anteroseptal wall defects. For the four patients without an apparent myocardial perfusion defect seen on the planar image, the LAO tomogram showed a perfusion defect in three, and the RAO tomogram also showed the defect in three. One or the other of the two views demonstrated the defect for all 11 patients. The myocardial tomogram in the RAO projection, providing a sufficiently high-quality and high-contrast image, gives useful information complementary to the findings of the commonly used LAO projection in the evaluation of myocardial infarctions.

Tamaki, N.; Yonekura, Y.; Mukai, T.; Yamamoto, K.; Fujita, T.; Minato, K.; Ishii, Y.; Torizuka, K.; Kambara, H.; Kawai, C.



Effect of successful thrombolytic therapy on right ventricular function in acute inferior wall myocardial infarction  

SciTech Connect

In 19 patients undergoing intracoronary fibrinolytic therapy for acute myocardial infarction, the site of coronary obstruction was in the proximal right coronary artery. Time between onset of symptoms and hospitalization was less than 4 hours. These patients were studied prospectively by radionuclide techniques immediately after admission, 48 hours and 4 weeks after AMI. Right and left ventricular (RV and LV) ejection fractions (EF) were calculated from gated blood pool scintigrams and the size of the LV perfusion defect was assessed by thallium-201 scintigraphy. Before the intervention, RV performance was significantly lower (RVEF 29 +/- 8%) than normal (53 +/- 7%). The size of the LV perfusion defect was relatively small (less than 25% of LV circumference), and as a consequence, LV pump function was only marginally impaired (LVEF 54 +/- 11%). Recanalization of the infarct artery was achieved in 12 patients (group A); in 7 patients the infarct artery remained occluded (group B). Early after the intervention (48 hours), RV performance in group A recovered significantly (RVEF: 30 +/- 9% vs 39 +/- 7%, p less than 0.01), and further improvement was noted at 4 weeks (RVEF 43 +/- 5%, p less than 0.01).

Schuler, G.; Hofmann, M.; Schwarz, F.; Mehmel, H.; Manthey, J.; Tillmanns, H.; Hartmann, S.; Kuebler, W.



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

SciTech Connect

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.

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



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

SciTech Connect

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.

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



Contributions of subdiaphragmatic activity, attenuation, and diaphragmatic motion to inferior wall artifact in attenuation-corrected Tc99m myocardial perfusion SPECT  

Microsoft Academic Search

Background  Subdiaphragmatic activity and diaphragmatic motion both contribute to inferior wall artifacts in technetium 99m myocardial\\u000a perfusion single photon emission computed tomography (SPECT).\\u000a \\u000a \\u000a \\u000a Methods and Results  We used an anthropomorphic phantom with ventricular wall activity, liver\\/spleen inserts containing variable Tc-99m activity,\\u000a and variable vertical (diaphragmatic) motion amplitude. SPECT and transmission scans were obtained on a GE Optima NX camera.\\u000a Data were processed

Alexander G. Pitman; Victor Kalff; Bruce Van Every; Borghild Risa; Leighton R. Barnden; Michael J. Kelly



Radionuclide imaging of myocardial infarction using Tc-99m TBI  

SciTech Connect

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.

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



Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse  

Microsoft Academic Search

Introduction and hypothesis  Two-dimensional magnetic resonance imaging (MRI) demonstrates apical support and vaginal length contribute to anterior wall\\u000a prolapse (AWP). This paper describes a novel three-dimensional technique to examine the vagina and its relationship to pelvic\\u000a sidewalls at rest and Valsalva.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty women (10 with AWP and 10 with normal support) underwent pelvic magnetic resonance imaging at rest and Valsalva. Three-dimensional

Kindra A. Larson; Yvonne Hsu; Luyun Chen; James A. Ashton-Miller; John O. L. DeLancey



Simultaneous assessment of left ventricular wall motion and myocardial perfusion with technetium-99m-methoxy isobutyl isonitrile at stress and rest in patients with angina: Comparison with thallium-201 SPECT  

SciTech Connect

The newly developed technetium-99m ({sup 99m}Tc) isonitriles can be used for the simultaneous evaluation of ventricular function and myocardial perfusion. We compared technetium-99m hexakis-2-methoxy isobutyl isonitrile (({sup 99m}Tc) MIBI) derived first-pass left ventricular wall motion at stress and rest with simultaneous myocardial perfusion defined by ({sup 99m}Tc)MIBI SPECT. These results were then compared with {sup 201}TI SPECT. We examined 28 patients with coronary artery disease; 25 had a previous myocardial infarction. We found concordance between segmental wall motion and myocardial perfusion imaging in defining normal, ischemic, and infarcted myocardium in 68% and 69% of segments using ({sup 99m}Tc)MIBI and {sup 201}TI respectively. The best agreement between wall motion and myocardial perfusion was seen in the inferior wall, while most of the discrepancies were found at the apex. Agreement between ({sup 99m}Tc)MIBI and {sup 201}TI SPECT myocardial perfusion was seen in 93% of segments. Technetium-99m-MIBI appears to be an ideal radiopharmaceutical for the simultaneous evaluation of ventricular function and myocardial perfusion during stress and at rest.

Villanueva-Meyer, J.; Mena, I.; Narahara, K.A. (UCLA School of Medicine, Harbor-UCLA Medical Center, Torrance (USA))



Predicting Myocardial Functional Recovery After Acute Myocardial Infarction: Relationship Between Myocardial Strain and Coronary Flow Reserve  

PubMed Central

Background and Objectives The purpose of this study was to evaluate the relationship between myocardial strain and coronary flow reserve (CFR) in the prediction of myocardial functional recovery after acute myocardial infarction (AMI). Subjects and Methods Consecutive patients with anterior ST elevation AMI were analyzed. Left ventricular (LV) strain, determined by 2-dimensional speckle tracking imaging and CFR, determined by intracoronary flow measurement, were obtained on the same day, 3-5 days after primary percutaneous coronary intervention. A-strain was defined as the mean systolic longitudinal strain of 11 LV segments (out of 18) assumed to be supplied by the left anterior descending coronary artery (LAD). Functional recovery was defined as improved wall motion >1 grade seen in at least 2 contiguous dysfunctional segments by echocardiography at the 6-month follow-up. Results Of 20 patients, 8 patients had preserved CFR (>2.0) and 12 patients had impaired CFR (?2.0). There were no differences between the 2 CFR groups in LV ejection fractions and wall motion score indices in the LAD territory. However, A-strain was greater in patients with preserved CFR than in patients with impaired CFR (-6.4±2.0% vs. -4.6±1.4%, p=0.03). A-strain and CFR correlated well with each other (r=-0.49, p=0.03). Ten of 20 patients showed functional recovery at 6 months. Of clinical and echocardiographic parameters, A-strain was the only predictor of recovery (odds ratio 2.02, 95% confidence interval=1.03-3.97, p=0.04). For predicting recovery, the sensitivity and specificity were 80.0% and 80.0%, respectively, for CFR (cutoff=1.60), and 60.0% and 90.0%, respectively, for A-strain (cutoff=-6.13%). Conclusion Myocardial strain correlates well with the extent of microvascular integrity and can be used as a noninvasive method for predicting recovery after AMI.

Park, Seong-Mi; Hong, Soon-Jun; Kim, Yong-Hyun; Ahn, Chul-Min; Lim, Do-Sun



Fully automated wall motion and thickening scoring system for myocardial perfusion SPECT: method development and validation in large population  

PubMed Central

Background Objective assessment of wall motion (M) and thickening (T) will aid in diagnosis of Coronary Artery Disease (CAD) from myocardial perfusion SPECT (MPS). We aimed to develop and validate an improved fully automated M/T segmental scoring system for MPS. Methods 100 normal gated stress/rest Tc-99m sestamibi MPS scans from patients with low-likelihood of CAD (LLk) were used to derive the regional normal M/T ranges. A new automatic algorithm incorporated regional dependence on the global contractility in polar map coordinates by linear regression analysis and automatically derived 17-segment M (scale 0–5) and T (scale 0–3) scores. We validated this new method in 630 consecutive Tc-99m stress MPS studies in patients with suspected CAD and available correlating angiography, and an additional 241 LLk studies. Two independent observers with 12 and 30 years of experience in nuclear cardiology, blinded to clinical and angiographic data, scored M/T in 17-segments for all 971 studies. Results Computation time was < 1 sec per case. In the angiography group, there was a high correlation between the summed scores (averaged for 2 observers) and automatic scores with r=0.91 (slope=1.02, offset=0.2; p < 0.0001) for M and r=0.88 (slope=1.06, offset=0.28 for T; p < 0.0001). Weighted kappa was 0.63 for M and 0.57 for T, with expected agreement of 89% (M) and 91% (T) in individual segments (n=10710). Weighted kappa between 2 experts was 0.45 for M and 0.52 for T. The normalcy rate in LLk cases was 96% for automated M and 99% for T (summed score < 3). Detection of the angiographically significant disease by automated motion or thickening scoring was better than or equivalent to individual expert observer scoring, and better than the previous automated system. Conclusions Fully automated scoring of MPS regional ventricular function can be performed rapidly, is highly correlated with expert visual scoring, can outperform individual experienced observers in the detection of CAD by wall thickening from MPS, and avoids inter-observer variability.

Slomka, Piotr J.; Berman, Daniel S.; Xu, Yuan; Kavanagh, Paul; Hayes, Sean W.; Dorbala, Sharmila; Fish, Mathews; Germano, Guido



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

SciTech Connect

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.

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.



Cardiac anaphylaxis: a case of acute ST-segment elevation myocardial infarction after IM epinephrine for anaphylactic shock.  


A 62-year-old male smoker with no other comorbidities presented to emergency department with systemic anaphylaxis, due to oral diclofenac for toothache. He developed acute anterior wall myocardial infarction following IM epinephrine 1 mg 1:1000. Primary percutaneous coronary intervention was done, which showed a thrombus in the mid left anterior descending artery with no evidence of obstructive coronary artery disease after thrombus aspiration. PMID:23706578

Tummala, Karthik; Maniyal, Vijay K; Chandrashekaran, Rajiv; Mathew, Navin; Ganeshwala, Gaurav



Evaluation of left ventricular wall motion and function in patients with previous myocardial infarction by three-dimensional 99m Tc-HSAD multigated cardiac pool imaging  

Microsoft Academic Search

To evaluate left ventricular (LV) wall motion stereoscopically from all directions and to calculate the LV volume by three-dimensional\\u000a (3D) imaging,99mTc-DTPA human serum albumin-multigated cardiac pool-single photon emission computed tomography (99mTc-MUGA-SPECT) was performed. A new data processing program was developed with the Application Visualization System-Medical\\u000a Viewer (AVS-MV) based on images obtained from99mTc-MUGA-SPECT. In patients with previous myocardial infarction, LV function

Junichi Yamazaki; Katsutoshi Naitou; Shuichi Ishida; Nariaki Uno; Kenichiro Saisho; Takehiko Munakata; Takeshi Morishita; Masaaki Takano; Yoshimasa Yabe



Ventricular late potential duration correlates to the time of onset of electrical transients during ventricular activation in subjects post-acute myocardial infarction.  


Ventricular late potentials (VLP) are electrical signals detected at the terminal region of the ventricular activation on surface ECG and often correlated to regions of fragmented electrical conduction in subjacent damaged myocardium. Intraventricular electrical transients (IVET) arisen from myocardial infarction scars may influence VLP identification depending on transient time of onset and duration. Seventy-six subjects after first ST elevation acute myocardial infarction (STEAMI) VLP were stratified according to initial myocardial wall insulted, whether anterior or inferior wall and electrical transient tracked throughout ventricular activation using spectral turbulence analysis technique. VLP were more prevalent in inferior than anterior STEAMI. No differences regarding IVET duration was observed between anterior and inferior STEAMI. Time of onset but not duration of IVET correlated to VLP duration. Scar location after STEAMI influences detection ventricular late potentials in SAECG. PMID:17692944

Benchimol-Barbosa, Paulo R; Muniz, Rafael Tostes



Evaluation of myocardial damage in Duchenne's muscular dystrophy with thallium-201 myocardial SPECT.  


Myocardial damage and cardiopulmonary functions in patients with Duchenne's muscular dystrophy (DMD) were assessed using thallium-201 myocardial single-photon emission computed tomography (SPECT) and technetium-99m multigated radionuclide angiography. Twenty-five patients with DMD were divided into 4 groups according to percent of perfusion defect (%PD) calculated by the bull's-eye method and age. PD was detected in 24 (96.0%) of 25 patients with DMD, and it spread from the left ventricular lateral wall to the anterior wall and/or interventricular septum. PD was detected even in a 6-year-old DMD boy. Patients in Group I (%PD > or = 10 and age < 15 years old) were shown to have a higher risk of left-sided heart failure without respiratory failure. Patients in Group II (%PD > or = 10 and age > or = 15) showed decreased pulmonary function and worsened arterial blood gas values as compared with Group IV (%PD < 10 and age > or = 15). There was no significant difference in cardiac function among the 4 groups. It is postulated that myocardial damage in Group II patients is dependent primarily on a deficiency of dystrophin and on chronic respiratory failure, and that some of them are at risk of cardiopulmonary failure. It is concluded that myocardial SPECT is useful for the early diagnosis of myocardial damage and evaluation of cardiopulmonary function in DMD patients. PMID:8515572

Tamura, T; Shibuya, N; Hashiba, K; Oku, Y; Mori, H; Yano, K



The development of the anterior abdominal wall in the rat in the light of a new anatomical description.  

PubMed Central

The development of the ventral abdominal muscles of the albino rat was studied histologically in 60 embryos and 10 postnatal specimens. The lower thoracic myotomes were seen to migrate ventrally in the lateral body wall, cross the middle line and continue with their contralateral fellows of the opposite side, thus forming a digastric mesodermal primordium. Differentiation of this primordium into fleshy bellies and intermediate aponeuroses occurred later in the prenatal period. Similar to the bilaminar arrangement of each of the human abdominal aponeuroses, recently described, each of the ventral abdominal muscles of the rat embryo was temporarily bilaminar; and similar to the trilaminar (plywood) arrangement of each wall of the human rectus sheath, the three lateral abdominal muscles of the rat embryo were so arranged. The tendinous intersections of the rectus muscle were seen only postnatally. They might be considered less as the remnants of a segmental origin, but rather as the intermediate tendons of a multigastric longitudinal muscle column. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8

Rizk, N N; Adieb, N



Quantitative Contrast-Enhanced First-Pass Cardiac Perfusion MRI at 3T with Accurate Arterial Input Function and Myocardial Wall Enhancement  

PubMed Central

Purpose To develop, and validate in vivo, a robust quantitative first-pass perfusion cardiovascular MR (CMR) method with accurate arterial input function (AIF) and myocardial wall enhancement. Materials and Methods A saturation-recovery (SR) pulse sequence was modified to sequentially acquire multiple slices after a single non-selective saturation pulse at 3T. In each heartbeat, an AIF image is acquired in the aortic root with a short TD (50ms), followed by the acquisition of myocardial images with longer TD values (~150-400ms). Longitudinal relaxation rates (R1=1/T1) were calculated using an ideal saturation recovery equation based on the Bloch equation, and corresponding gadolinium contrast concentrations were calculated assuming fast water exchange condition. The proposed method was validated against a reference multi-point SR method by comparing their respective R1 measurements in the blood and left ventricular myocardium, prior to and at multiple time-points following contrast injections, in 7 volunteers. Results R1 measurements with the proposed method and reference multi-point method were strongly correlated (r>0.88, P<10?5) and in good agreement (mean difference ±1.96 standard deviation 0.131 ± 0.317 / 0.018 ± 0.140 s?1 for blood/myocardium, respectively). Conclusion The proposed quantitative first-pass perfusion CMR method measured accurate R1 values for quantification of AIF and myocardial wall contrast agent concentrations in 3 cardiac short-axis slices, in a total acquisition time of 523ms per heartbeat.

Breton, Elodie; Kim, Daniel; Chung, Sohae; Axel, Leon



Nonuniformity in myocardial accumulation of fluorine-18-fluorodeoxyglucose in normal fasted humans  

SciTech Connect

In initial studies using fluorine-18-fluorodeoxyglucose (FDG) in normal fasted subjects, we observed disparities in the regional myocardial accumulation of this tracer. Accordingly, we systematically evaluated regional myocardial FDG accumulation in comparison with regional myocardial perfusion assessed with oxygen-15-water and oxidative metabolism assessed with carbon-11-acetate in nine normal subjects (four studied after a 5-hr fast and five studied both fasted and following glucose loading). Under fasting conditions, myocardial accumulation of FDG in the septum and anterior wall averaged 80% of that in the lateral and posterior walls (p less than 0.03). In contrast, after glucose loading the regional distribution of myocardial FDG accumulation became more homogeneous. Regional myocardial perfusion, oxidative metabolism, and accumulation of carbon-11-acetate were homogeneous under both conditions. Thus, under fasting conditions there are regional variations in myocardial accumulation of FDG, which are visually apparent, are not associated with concomitant changes in oxidative metabolism or perfusion, and cannot be attributed to partial-volume effects. This significant heterogeneity may limit the specificity of PET with FDG for detecting myocardial ischemia in fasting subjects.

Gropler, R.J.; Siegel, B.A.; Lee, K.J.; Moerlein, S.M.; Perry, D.J.; Bergmann, S.R.; Geltman, E.M. (Edward Mallinckrodt Institute of Radiology, St. Louis, MO (USA))



Heterogeneity of Left Ventricular Wall Thickening Mechanisms  

PubMed Central

Background: Myocardial fibers are grouped into lamina (or sheets) 3-4 cells thick. Fiber shortening produces systolic LV wall thickening primarily by laminar extension, thickening and shear, but the regional variability and transmural distribution of these three mechanisms are incompletely understood. Methods and Results: Nine sheep had transmural radiopaque markers inserted into the anterior basal and lateral equatorial LV. 4D marker dynamics were studied with biplane videofluoroscopy to measure circumferential, longitudinal, and radial systolic strains in the epicardium, midwall, and endocardium. Fiber and sheet angles from quantitative histology allowed transformation of these strains into transmural contributions of sheet extension, thickening, and shear to systolic wall thickening. At all depths, systolic wall thickening in the anterior basal region was 1.6-1.9 times that in the lateral equatorial region. Interestingly, however, systolic fiber shortening was identical at each transmural depth in these regions. Endocardial anterior basal sheet thickening were >2x greater than in the lateral equatorial region (epicardium: 0.16±0.15 vs. 0.03±0.06; endocardium: 0.45±0.40 vs. 0.17±0.09). Midwall sheet extension was >2x that in the lateral wall (0.22±0.12 vs. 0.09±0.06). Epicardial and midwall sheet shears in the anterior wall were ?2x higher than in the lateral wall (epicardium: 0.14±0.07 vs. 0.05±0.03; midwall: 0.21±0.12 vs. 0.12±0.06). Conclusions: These data demonstrate fundamentally different regional contributions of laminar mechanisms for amplifying fiber shortening to systolic wall thickening. Systolic fiber shortening was identical at each transmural depth in both the anterior and lateral LV sites. However, systolic wall thickening of the anterior site was much greater than that of the lateral site. Fiber shortening drives systolic wall thickening, but sheet dynamics and orientations are of great importance to systolic wall thickening. LV wall thickening and its clinical implications pivot on different wall thickening mechanisms in various LV regions. Attempts to implant healthy contractile cells into diseased hearts or surgically manipulate LV geometry will need to take into account not only cardiomyocyte contraction, but also transmural LV intercellular architecture and geometry.

Cheng, Allen; Nguyen, Tom C.; Malinowski, Marcin; Daughters, George T.; Miller, D. Craig; Ingels, Neil B.



Myocardial perfusion modeling using MRI.  


In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery turbo-FLASH (fast low-angle shot) sequence and Gd-DTPA has been presented. Here, an extension of the model is presented taking into account fast and slow water exchange between the compartments, enabling the calculation of the unidirectional influx constant (Ki) for Gd-DTPA, the distribution volume of Gd-DTPA (lambda), the vascular blood volume (Vb), and the time delay through the coronary arteries (delta T). The model was evaluated by computer simulation and used on experimental results from seven healthy subjects. The results in the healthy volunteers for a region of interest placed in the anterior myocardial wall were (mean +/- SD) Ki = 54 +/- 10 ml/100 g/min, lambda = 30 +/- 3 ml/100 g, Vb = 9 +/- 2 ml/100 g, delta T = 3.2 +/- 1.1 s. These results are in good agreement with similar results obtained by other methods. PMID:8722823

Larsson, H B; Fritz-Hansen, T; Rostrup, E; Søndergaard, L; Ring, P; Henriksen, O



Effects of nitroglycerin on myocardial excursions and velocities in the early hours of acute myocardial infarction.  


The effects of sublingual nitroglycerin on septal and left ventricular wall motion were determined by echocardiography in the early hours of acute myocardial infarction (MI) in 20 patients admitted via a mobile coronary care unit. Left ventricular and septal echoes were obtained in 11 patients with acute anterior MI and in 9 with acute inferior MI before and after administration of 500 micrograms sublingual nitroglycerin. In the group with acute anterior MI, nitroglycerin did not significantly affect the B-C excursion, posterior wall excursion, and mean posterior wall velocity. Nitroglycerin significantly increased (P less than 0.01), however, the systolic septal excursion, systolic septal velocity, diastolic septal excursion, and diastolic septal velocity. In the group with acute inferior MI, nitroglycerin significantly increased the B-C excursion (P less than 0.01); posterior wall excursion (P less than 0.01); mean posterior wall velocity (P less than 0.01); systolic septal excursion (P less than 0.01); diastolic septal excursion (P less than 0.05), and diastolic septal velocity (P = 0.01) but did not affect the systolic septal velocity. All measurements were obtained by use of a method of labeling and describing specific points of the wall motion that has been described recently. PMID:2504080

Kounis, N G; Zavras, G M; Papadaki, P J; Soufras, G D; Kitrou, M P



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

SciTech Connect

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.

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



Regional wall thickening of left ventricle evaluated by gated positron emission tomography in relation to myocardial perfusion and glucose metabolism  

Microsoft Academic Search

Regional wall thickening was assessed by electrocardiographically gated positron emission tomography (ECG-gated PET) in 26 patients with coronary artery disease. The standardized percent count increase from end-diastole to end-systole (S-percent Cl) was calculated as an index of wall thickening. The S-percent Cl was 77.8% +\\/- 28.9% in the segments with normal perfusion at rest, 51.9% +\\/- 29.5% in those with

Keiji Yamashita; Nagara Tamaki; Yoshiharu Yonekura; Hiroshi Ohtani; Yasuhiro Magata; Ryuji Nohara; Hirofumi Kambara; Chuichi Kawai; Toshihiko Ban; Junji Konishi



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

SciTech Connect

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.

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



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

PubMed Central

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

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



Placental growth factor increases regional myocardial blood flow and contractile function in chronic myocardial ischemia.  


Placental growth factor (PlGF) has a distinct biological phenotype with a predominant proangiogenic role in disease without affecting quiescent vessels in healthy organs. We tested whether systemic administration of recombinant human (rh)PlGF improves regional myocardial blood flow (MBF) and systolic function recovery in a porcine chronic myocardial ischemia model. We implanted a flow-limiting stent in the proximal left anterior descending coronary artery and measured systemic hemodynamics, regional myocardial function using MRI, and blood flow using colored microspheres 4 wk later. Animals were then randomized in a blinded way to receive an infusion of rhPlGF (15 ?g·kg(-1)·day(-1), n = 9) or PBS (control; n = 10) for 2 wk. At 8 wk, myocardial perfusion and function were reassessed. Infusion of rhPlGF transiently increased PlGF serum levels >30-fold (1,153 ± 180 vs. 33 ± 18 pg/ml at baseline, P < 0.001) without affecting systemic hemodynamics. From 4 to 8 wk, rhPlGF increased regional MBF from 0.46 ± 0.11 to 0.85 ± 0.16 ml·min(-1)·g(-1), with a concomitant increase in systolic wall thickening from 11 ± 3% to 26 ± 5% in the ischemic area. In control animals, no significant changes from 4 to 8 wk were observed (MBF: 0.45 ± 0.07 to 0.49 ± 0.08 ml·min(-1)·g(-1) and systolic wall thickening: 14 ± 4% to 18 ± 1%). rhPlGF-induced functional improvement was accompanied by increased myocardial neovascularization, enhanced glycogen utilization, and reduced oxidative stress and cardiomyocyte apoptosis in the ischemic zone. In conclusion, systemic rhPlGF infusion significantly enhances regional blood flow and contractile function of the chronic ischemic myocardium without adverse effects. PlGF protein infusion may represent an attractive therapeutic strategy to increase myocardial perfusion and energetics in chronic ischemic cardiomyopathy. PMID:23316060

Liu, Xiaoshun; Claus, Piet; Wu, Ming; Reyns, Geert; Verhamme, Peter; Pokreisz, Peter; Vandenwijngaert, Sara; Dubois, Christophe; Vanhaecke, Johan; Verbeken, Erik; Bogaert, Jan; Janssens, Stefan



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

SciTech Connect

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.

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



Early-phase myocardial infarction: Evaluation by MR imaging  

SciTech Connect

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.

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



Underestimation of residual ischemia by 201-thallium scintigraphy after myocardial infarction  

SciTech Connect

Pre- and post-CABG perfusion scintigraphic findings are reported in a patient with residual ischemia after anterior myocardial infarction. The preoperative /sup 201/Tl scan showed incomplete tracer redistribution and a relevant area of persistent irreversible defect, suggestive of a large scar. After CABG, the presence of a virtually normal early thallium distribution demonstrated previous underestimation of the viable perinecrotic tissue. A persistent perfusion defect, even if associated with wall motion abnormality, does not necessarily imply the absence of residual viable tissue.

Galli, M.; Bencivelli, W.; Pardo, N.F.; Tavazzi, L.



Myocardial infarction following a bee sting  

Microsoft Academic Search

We described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. She developed a typical course of myocardial infarction; the ECG changes were reversed to almost all normal limits. She had normal coronary angiography and reversible wall motion abnormalities. Myocardial damage following prolonged spasm in the coronary arteries may be

Ceyhun Ceyhan; Ertu?rul Ercan; Tarkan Tekten; Bahadir Kirilmaz; Remzi Önder



Myocardial Blood Volume Is Associated with Myocardial Oxygen Consumption: An Experimental Study with CMR in a Canine Model  

PubMed Central

OBJECTIVES To evaluate the feasibility of cardiovascular MR (CMR) to determine regional myocardial perfusion and O2 metabolism, and assess the role of myocardial blood volume (MBV) on oxygen supply. BACKGROUND Coronary artery disease presents as an imbalance of myocardial oxygen supply and demand. We have developed relevant CMR methods to determine the relationship of myocardial blood flow (MBF) and MBV to oxygen consumption (MVO2) during pharmacologic hyperemia. METHODS Twenty-one mongrel dogs were studied with varying stenosis severities imposed on the proximal left anterior descending (LAD) coronary artery. MBF and MBV were determined by CMR first-pass perfusion, while the oxygen extraction fraction (OEF) and MVO2 were determined by the myocardial Blood-Oxygen-Level-Dependent (BOLD) effect and Fick’s law, respectively. MR imaging was performed at rest, and during either dipyridamole-induced vasodilation or dobutamine-induced hyperemia. Regional differences in myocardial perfusion and oxygenation were then evaluated. RESULTS Dipyridamole and dobutamine both led to 145–200% increases in MBF and 50–80% increases in MBV in normal perfused myocardium. As expected, MVO2 increased more significantly with dobutamine (~175%) than dipyridamole (~40%). Coronary stenosis resulted in an attenuation of MBF, MBV, and MVO2 in both the LAD-subtended stenosis region and the left circumflex subtended remote region. Liner regression analysis showed that MBV reserve appears to be more correlated with MVO2 reserve during dobutamine stress than MBF reserve, particularly in the stenotic regions. Conversely, MBF reserve appears to be more correlated with MVO2 reserve during dipyridamole, although neither of these differences was significant. CONCLUSIONS Noninvasive evaluation of both myocardial perfusion and oxygenation by CMR facilitates direct monitoring of regional myocardial ischemia and provides a valuable tool for better understanding microvascular pathophysiology. These techniques could complement delayed enhancement and wall motion analysis protocols, making MRI a valuable “one-stop shop” for imaging of myocardial ischemia.

McCommis, Kyle S.; Zhang, Haosen; Goldstein, Thomas A.; Misselwitz, Bernd; Abendschein, Dana R.; Gropler, Robert J.; Zheng, Jie



Regional wall thickening of left ventricle evaluated by gated positron emission tomography in relation to myocardial perfusion and glucose metabolism  

SciTech Connect

Regional wall thickening was assessed by electrocardiographically gated positron emission tomography (ECG-gated PET) in 26 patients with coronary artery disease. The standardized percent count increase from end-diastole to end-systole (S-percent Cl) was calculated as an index of wall thickening. The S-percent Cl was 77.8% +/- 28.9% in the segments with normal perfusion at rest, 51.9% +/- 29.5% in those with mild hypoperfusion, and 32.8% +/- 30.9% in those with severe hypoperfusion (p less than 0.001, each). Among the segments with resting hypoperfusion, the S-percent Cl was 38.9% +/- 31.5% in those without stress-induced ischemia and 48.7% +/- 30.9% in those with ischemia (p less than 0.05). Furthermore, among resting severe hypoperfusion, the S-percent Cl was 23.0% +/- 23.9% in the segments without fluorine-18-fluorodeoxyglucose (FDG) uptake and 37.8 +/- 32.9% in those with FDG uptake (p less than 0.05). These results suggest that stress-induced ischemia and FDG accumulation correlated with wall thickening. Thus, quantitative analysis of regional wall thickening seems to be useful for combined analysis of regional function, perfusion and metabolism in coronary patients.

Yamashita, K.; Tamaki, N.; Yonekura, Y.; Ohtani, H.; Magata, Y.; Nohara, R.; Kambara, H.; Kawai, C.; Ban, T.; Konishi, J. (Kyoto Univ. (Japan))



Transmural Myocardial Mechanics During Isovolumic Contraction  

PubMed Central

OBJECTIVES We sought to resolve the 3-dimensional transmural heterogeneity in myocardial mechanics observed during the isovolumic contraction (IC) phase. BACKGROUND Although myocardial deformation during IC is expected to be little, recent tissue Doppler imaging studies suggest dynamic myocardial motions during this phase with biphasic longitudinal tissue velocities in left ventricular (LV) long-axis views. A unifying understanding of myocardial mechanics that would account for these dynamic aspects of IC is lacking. METHODS We determined the time course of 3-dimensional finite strains in the anterior LV of 14 adult mongrel dogs in vivo during IC and ejection with biplane cineradiography of implanted transmural markers. Transmural fiber orientations were histologically measured in the heart tissue postmortem. The strain time course was determined in the subepicardial, midwall, and subendocardial layers referenced to the end-diastolic configuration. RESULTS During IC, there was circumferential stretch in the subepicardial layer, whereas circumferential shortening was observed in the midwall and the subendocardial layer. There was significant longitudinal shortening and wall thickening across the wall. Although longitudinal tissue velocity showed a biphasic profile; tissue deformation in the longitudinal as well as other directions was almost linear during IC. Subendocardial fibers shortened, whereas subepicardial fibers lengthened. During ejection, all strain components showed a significant change over time that was greater in magnitude than that of IC. Significant transmural gradient was observed in all normal strains. CONCLUSIONS IC is a dynamic phase characterized by deformation in circumferential, longitudinal, and radial directions. Tissue mechanics during IC, including fiber shortening, appear uninterrupted by rapid longitudinal motion created by mitral valve closure. This study is the first to report layer-dependent deformation of circumferential strain, which results from layer-dependent deformation of myofibers during IC. Complex myofiber mechanics provide the mechanism of brief clockwise LV rotation (untwisting) and significant wall thickening during IC within the isovolumic constraint.

Ashikaga, Hiroshi; van der Spoel, Tycho I. G.; Coppola, Benjamin A.; Omens, Jeffrey H.



In Hypertrophic Cardiomyopathy Reduction of Relative Resting Myocardial Blood Flow Is Related to Late Enhancement, T2-Signal and LV Wall Thickness  

PubMed Central

Objectives To quantify resting myocardial blood flow (MBF) in the left ventricular (LV) wall of HCM patients and to determine the relationship to important parameters of disease: LV wall thickness, late gadolinium enhancement (LGE), T2-signal abnormalities (dark and bright signal), LV outflow tract obstruction and age. Materials and Methods Seventy patients with proven HCM underwent cardiac MRI. Absolute and relative resting MBF were calculated from cardiac perfusion MRI by using the Fermi function model. The relationship between relative MBF and LV wall thickness, T2-signal abnormalities (T2 dark and T2 bright signal), LGE, age and LV outflow gradient as determined by echocardiography was determined using simple and multiple linear regression analysis. Categories of reduced and elevated perfusion in relation to non- or mildly affected reference segments were defined, and T2-signal characteristics and extent as well as pattern of LGE were examined. Statistical testing included linear and logistic regression analysis, unpaired t-test, odds ratios, and Fisher’s exact test. Results 804 segments in 70 patients were included in the analysis. In a simple linear regression model LV wall thickness (p<0.001), extent of LGE (p<0.001), presence of edema, defined as focal T2 bright signal (p<0.001), T2 dark signal (p<0.001) and age (p?=?0.032) correlated inversely with relative resting MBF. The LV outflow gradient did not show any effect on resting perfusion (p?=?0.901). Multiple linear regression analysis revealed that LGE (p<0.001), edema (p?=?0.026) and T2 dark signal (p?=?0.019) were independent predictors of relative resting MBF. Segments with reduced resting perfusion demonstrated different LGE patterns compared to segments with elevated resting perfusion. Conclusion In HCM resting MBF is significantly reduced depending on LV wall thickness, extent of LGE, focal T2 signal abnormalities and age. Furthermore, different patterns of perfusion in HCM patients have been defined, which may represent different stages of disease.

Hueper, Katja; Zapf, Antonia; Skrok, Jan; Pinheiro, Aurelio; Goldstein, Thomas A.; Zheng, Jie; Zimmerman, Stefan L.; Kamel, Ihab R.; Abraham, Roselle; Wacker, Frank; Bluemke, David A.; Abraham, Theodore; Vogel-Claussen, Jens



Doughnut technetium pyrophosphate myocardial scintigrams. A marker of severe left ventricular dysfunction  

SciTech Connect

The doughnut pattern on /sup 99m/Tc pyrophosphate (PPi) myocardial scintigraphy is characterized by a border of tracer uptake surrounding a central zone of relatively decreased activity. This pattern is generally associated with large transmural anterior myocardial infarcts (MI) caused by occlusion or critical stenosis of the left anterior descending coronary artery. Such infarcts typically involve a significant portion of the anterior wall and are associated with a complicated clinical course and poor prognosis. In order to evaluate the relationship between the presence of the doughnut pattern and left ventricular (LV) function, radionuclide ventriculography was performed within 15 days after infarction in 58 patients with transmural anterior MI. In patients without previous MI, 15/38 (39.5%) had doughnut scintigrams. These patients demonstrated significant reductions in LV ejection fraction (EF) (28 +/- 10% versus 45 +/- 12%, P less than 0.001) and normalized LV wall motion scores (29 +/- 11% versus 61 +/- 10%, P less than 0.001) when compared with patients with nondoughnut scintigrams. Patients with doughnut scintigrams had a significantly greater incidence of severe septal hypokinesis (P less than 0.001) and apical dyskinesis (P less than 0.03). LV end-systolic volumes were also larger in the patients with doughnut scintigrams (73 +/- 32 ml versus 40 +/- 17 mI/M2, P less than 0.005). In contrast, there was no significant difference in LVEF, normalized LV wall motion score, or LV volumes between doughnut and nondoughnut groups in patients with previous MI.

Nicod, P.; Corbett, J.R.; Rude, R.E.; Dehmer, G.J.; Smucker, M.; Buja, L.M.; Parkey, R.W.; Lewis, S.E.; Willerson, J.T.



New automated Markov-Gibbs random field based framework for myocardial wall viability quantification on agent enhanced cardiac magnetic resonance images.  


A novel automated framework for detecting and quantifying viability from agent enhanced cardiac magnetic resonance images is proposed. The framework identifies the pathological tissues based on a joint Markov-Gibbs random field (MGRF) model that accounts for the 1st-order visual appearance of the myocardial wall (in terms of the pixel-wise intensities) and the 2nd-order spatial interactions between pixels. The pathological tissue is quantified based on two metrics: the percentage area in each segment with respect to the total area of the segment, and the trans-wall extent of the pathological tissue. This transmural extent is estimated using point-to-point correspondences based on a Laplace partial differential equation. Transmural extent was validated using a simulated phantom. We tested the proposed framework on 14 datasets (168 images) and validated against manual expert delineation of the pathological tissue by two observers. Mean Dice similarity coefficients (DSC) of 0.90 and 0.88 were obtained for the observers, approaching the ideal value, 1. The Bland-Altman statistic of infarct volumes estimated by manual versus the MGRF estimation revealed little bias difference, and most values fell within the 95% confidence interval, suggesting very good agreement. Using the DSC measure we documented statistically significant superior segmentation performance for our MGRF method versus established intensity-based methods (greater DSC, and smaller standard deviation). Our Laplace method showed good operating characteristics across the full range of extent of transmural infarct, outperforming conventional methods. Phantom validation and experiments on patient data confirmed the robustness and accuracy of the proposed framework. PMID:22160668

Elnakib, Ahmed; Beache, Garth M; Gimel'farb, Georgy; El-Baz, Ayman



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

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.

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



Videometric analysis of regional left ventricular function before and after aortocoronary artery bypass surgery: correlation of peak rate of myocardial wall thickening with late postoperative graft flows.  

PubMed Central

The peak rate of systolic wall thickening (pdTw/dt) in regions of the left ventricle was determined by biplane roentgen videometry in 60 patients before and a median of 14 mo after aorto-coronary bypass graft surgery. The left ventricular ejection fraction, stroke volume, and end-diastolic volume and pressure did not change significantly after surgery in the presence of patent or occluded grafts (P greater than 0.05). Statistically significant increases occurred in the peak rate of systolic wall thickening regions supplied by patent bypass grafts, and significant decreases occurred in regions with occluded grafts (P less than 0.01). Of 42 preoperatively hypokinetic regions (pdTw/dt greater than 0 less than 5.0 cm/s) supplied by a patent graft, 30 improved by an average of 2.6 cm/s after operation; 18 returned to normal. Failure of 24 hypokinetic regions to improve to normal was associated with myocardial infarction in 11 or with late postoperative graft blood flows of less than 60 ml/min measured by videodensitometry, in 10. All seven preoperatively akinetic (pdTw/dt=0) or dyskinetic (pdTw/dt less than 0) regions did not improve after the operation despite the fact that, in five of the seven, coronary bypass flows were over 60 ml/min. All eight preoperatively hypokinetic regions supplied by coronary artery graft flows of less than or equal 40 ml/min failed to improve to normal after operation. All nine preoperatively hypokinetic regions supplied by coronary artery graft flows of over 60 ml/min improved to normal after surgery. Late postoperative coronary artery bypass graft flows, the functional status of the myocardium, the status and distribution of the native coronary circulation, and decreased regional function elsewhere in the ventricle must all be considered when regional left ventricular function is interpreted.

Chesebro, J H; Ritman, E L; Frye, R L; Smith, H C; Connolly, D C; Rutherford, B D; Davis, G D; Danielson, G K; Pluth, J R; Barnhorst, D A; Wallace, R B



Regional myocardial wall thickening and global ejection fraction in patients with low angiographic left ventricular ejection fraction assessed by visual and quantitative resting ECG-gated 99m Tc-tetrofosmin single-photon emission tomography and magnetic resonance imaging  

Microsoft Academic Search

.   We investigated the use of visual and quantitative technetium 99m tetrofosmin ECG-gated single-photon emission tomography\\u000a (SPET) for the assessment of regional myocardial wall thickening (WT) and left ventricular (LV) ejection fraction (EF) in\\u000a comparison with gated magnetic resonance imaging (MRI) in patients with a low angiographic LVEF. Gated SPET using 99mTc-labelled flow tracers offers potential for simultaneous assessment of

Jens C. Stollfuss; Felix Haas; Ichiro Matsunari; Jodi Neverve; Stephan Nekolla; Jan Schneider-Eicke; Ullrich Schricke; Sybille Ziegler; Markus Schwaiger



Simultaneous analysis of wall motion and coronary flow reserve of the left anterior descending coronary artery by transthoracic doppler echocardiography during dipyridamole stress echocardiography  

Microsoft Academic Search

BackgroundCoronary flow reserve (CFR) can be measured in the left anterior descending artery (LAD) by dipyridamole transthoracic Doppler echocardiography (DTTDE). This information may critically improve the diagnostic accuracy of dipyridamole stress echocardiography, which is limited by moderate sensitivity.

Jorge Lowenstein; Cristian Tiano; Gustavo Marquez; Cecilia Presti; Cristina Quiroz



Myocardial bridging: light in the tunnel  

Microsoft Academic Search

Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally\\u000a considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial\\u000a ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with\\u000a a myocardial bridge in left anterior

M. Martín; E. Romero Tarín; Luis H. Luyando; Juan Rondán; Carlos Morales



Measurement of regional myocardial blood flow in hypertrophic cardiomyopathy: Application of the first-pass flow model using ( sup 13 N)ammonia and PET  

SciTech Connect

Positron emission tomography (PET) has become an important tool in the study of regional myocardial blood flow. The purpose of the present study was to measure regional myocardial blood flow using dynamic ({sup 13}N)ammonia PET and the first-pass flow model. Thirteen patients with hypertrophic cardiomyopathy, and with a considerably thickened ventricular wall (25 mm or greater), were selected for the study in order to minimize errors due to spillover of radioactivity from blood to the myocardium and to the underestimation of myocardial activity caused by the partial volume effect. Arterial input function was determined by assigning a region of interest to the left atrial cavity on the PET images. Using left atrial and myocardial time-activity curves, regional myocardial blood flow was calculated using the first-pass flow model. Mean myocardial blood flow ranged from 47.8 to 76.5 ml/min per 100 g (63.0 +/- 9.4). Regional myocardial blood flow in the septum was significantly lower than in the anterior and lateral walls of the left ventricle (P less than .01). These results indicate the potential usefulness of dynamic PET in the measurement of regional myocardial blood flow in man.

Yoshida, K.; Endo, M.; Himi, T.; Kagaya, A.; Masuda, Y.; Inagaki, Y.; Fukuda, H.; Iinuma, T.; Yamasaki, T.; Fukuda, N. (Chiba Univ. School of Medicine (Japan))



Recanalization of a chronic totally occluded left anterior descending artery after enhanced external counterpulsation therapy.  


We present a case of a 52 y/o male with history of hypertension and high cholesterol who suffered an acute myocardial infarction. His catheterization revealed severe 3-vessel coronary artery disease with total occlusion of left anterior descending (LAD) artery at the mid segment with anterior and apical wall dyskinesia and estimated ejection fraction of 30%. After 3 years of medical therapy the patient had NYHA class II heart failure symptoms without angina. Enhanced external counterpulsation (EECP) therapy was offered as adjunctive therapy. After completing therapy patient started to develop angina and a new catheterization showed recanalization of LAD with TIMI I flow and normal ejection fraction without wall motion abnormalities. Patient underwent successful coronary artery bypass graft. PMID:19610581

Salgado, Víctor; Salgado, Carlos; Medina, Arturo


Early radionuclide scans for risk assessment in suspected acute myocardial infarction.  

PubMed Central

First-day thallium-201 myocardial perfusion scans and technetium-99m RBC gated scintiangiography were performed during the initial clinical and prognostic evaluation of 69 patients with suspected acute myocardial infarction. Patients were monitored for clinical course, diagnosis confirmation, and use of specialty services (cardiac catheterization, percutaneous balloon angioplasty, and cardiac surgery) during hospitalization. Myocardial infarction, confirmed in 20 patients, was associated with significantly more left ventricular dilatation, lower ejection fractions, lower peak left ventricular filling rates, wall motion abnormalities, and thallium-201 perfusion defects than nonmyocardial infarction patients. Among all patients, left ventricular dilatation carried a relative risk of myocardial infarction of 5.8; low ejection fraction and right ventricular dilatation were strongly associated with myocardial infarction. A logistic model for congestive heart failure included: left ventricular dilation, lower mean left ventricular filling rates and time to peak filling rates, and abnormal thallium-201 lung:heart uptakes. Among nonmyocardial infarction patients, subsequent cardiac catheterization was predicted by the presence of anterior thallium-201 perfusion defects, Killip functional class II-III, and ischemia on ECG. These findings suggest that early detection of myocardial perfusion defects and cardiac dysfunction by radionuclide scans enhances initial evaluation of suspected acute myocardial infarction patients. Additional studies are needed to confirm these findings.

Norris, S. L.; Haywood, L. J.; Sobel, E.; Hung, G. L.; deGuzman, M.; Siegel, M.



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

SciTech Connect

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.

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



Non-invasive coronary flow reserve is correlated with microvascular integrity and myocardial viability after primary angioplasty in acute myocardial infarction  

Microsoft Academic Search

Objective: To test whether preserved coronary flow reserve (CFR) two days after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction (“ no-reflow” phenomenon) and is predictive of myocardial viability.Design: 24 patients with anterior AMI underwent CFR assessment in the left anterior descending coronary artery (LAD) with transthoracic echocardiography and myocardial contrast echocardiography (MCE) 48 h after primary

R Montisci; L Chen; M Ruscazio; P Colonna; C Cadeddu; C Caiati; M Montisci; L Meloni; S Iliceto



Doppler Myocardial Imaging: applicazioni cliniche  

Microsoft Academic Search

Doppler Myocardial Imaging is a new echocardiographic technique introduced by Isaaz and McDicken in 1992, extending the Doppler analysis from blood flows (with high velocity and low amplitude) to the cardiac wall motion (with low velocity and high amplitude), through opportune changes in the hardware and in the software of the ultrasound machine. Nowadays clinical applications of Doppler Myocardial Imaging

Pio Caso; Antonello D'Andrea; Alfonso Roberto Martiniello; Paolo Calabrò; Marco Pascotto; Caso Ilaria; Sergio Severino; Nicola Mininni


Changes in myocardial echo amplitude during reversible ischaemia in humans.  

PubMed Central

OBJECTIVE--This study investigated the changes in regional myocardial ultrasonic backscatter, measured as myocardial echo amplitude, that occur during reversible myocardial ischaemia in humans. DESIGN--Left anterior descending coronary angioplasty was used to produce reversible myocardial ischaemia in human subjects. Regional myocardial echo amplitude was studied in the interventricular septum and left ventricular posterior free wall before, during, and after coronary occlusion with the angioplasty balloon. Wall motion analysis of the left ventricle was performed from simultaneous cross sectional echocardiographic imaging. Patients were studied prospectively. PATIENTS--Six patients (mean age 56 (SD 11), range 46 to 69 years) with single vessel, left anterior descending coronary artery stenoses, were investigated during elective coronary angioplasty. A total of 11 balloon inflations were studied. SETTING--All patient studies were performed at Harefield Hospital. Echo amplitude analysis was performed at the Royal Brompton Hospital. INTERVENTIONS--Angioplasty was performed by the usual procedure at Harefield Hospital for elective coronary angioplasty. All routine medication including beta blockers and calcium antagonists were continued. Inflation pressures were up to 12 atm (1212 kPa) and mean inflation time ranged from 30 to 120 (86 (31)) s. In four studies the first inflation was examined, in three the second, in two the third, and in one each the fourth and fifth inflations. Echo amplitude and cross sectional echo-cardiographic studies were recorded with a 3.5 MHz Advanced Technology Laboratories (ATL) (720A/8736 series) mechanical sector scanner and an ATL Mark III (860-1 series) echocardiograph system with 45 dB logarithmic grey scale compression. MAIN OUTCOME MEASURES--Regional echo amplitude was examined in four regions of the left ventricle--namely, the basal and mid-septum, and basal and mid-posterior wall. Consecutive end diastolic and end systolic frames were analysed and cyclic variation was determined as the difference between the level of echo amplitude at end diastole and at end systole. Measurements were made before balloon inflation, at peak inflation, and after balloon deflation. Regional wall motion and systolic wall thickening were analysed qualitatively. RESULTS--Before balloon inflation, cyclic variation in echo amplitude was noted in all regions (basal septum, 2.4 (SD 1.1) dB; mid-septum, 2.5 (1.1) dB; basal posterior wall, 3.3 (2.1) dB; mid-posterior wall, 3.9 (1.6) dB). During balloon inflation there was a significant fall in cyclic variation to 0.4 (0.9) dB (p < 0.0002) in the mid-septum. This was predominantly owing to an increase in end systolic echo amplitude from 5.4 (2.0) dB to 9.3 (1.9) dB (p < or = 0.01). This was associated with the development of severe hypokinesis or akinesis in the mid-septum. No significant changes in echo amplitude occurred in the three other regions examined. Changes were completely reversed after balloon deflation. CONCLUSIONS--These results suggest a causal relation between occlusion of the supplying coronary artery and blunting of myocardial echo amplitude cyclic variation. It is suggested that balloon occlusion produced myocardial ischaemia. The resultant impairment of myocardial contraction then caused a blunting of cyclic variation in echo amplitude. The results of this study provide further data about the ability of quantitative studies of ultrasonic backscatter to identify alterations in the myocardium during injury.

Lythall, D A; Gibson, D G; Kushwaha, S S; Norell, M S; Mitchell, A G; Ilsley, C J



Treatment of Chronic Myocardial Ischemia: Rationale and Treatment Options  

Microsoft Academic Search

A rational approach to the treatment of chronic myocardial ischemia requires an appreciation of the pathophysiology of coronary artery disease and the treatment options available. Any factor that causes an imbalance between myocardial oxygen supply and demand can provoke ischemia. Myocardial oxygen requirements rise with increases in heart rate, contractility, or left ventricular wall stress. Myocardial oxygen supply is determined

Peter F. Cohn



Changes in regional myocardial volume during the cardiac cycle: implications for transmural blood flow and cardiac structure  

PubMed Central

Although previous studies report a reduction in myocardial volume during systole, myocardial volume changes during the cardiac cycle have not been quantitatively analyzed with high spatiotemporal resolution. We studied the time course of myocardial volume in the anterior mid-left ventricular (LV) wall of normal canine heart in vivo (n = 14) during atrial or LV pacing using transmurally implanted markers and biplane cineradiography (8 ms/frame). During atrial pacing, there was a significant transmural gradient in maximum volume decrease (4.1, 6.8, and 10.3% at subepi, midwall, and subendo layer, respectively, P = 0.002). The rate of myocardial volume increase during diastole was 4.7 ± 5.8, 6.8 ± 6.1, and 10.8 ± 7.7 ml·min?1·g?1, respectively, which is substantially larger than the average myocardial blood flow in the literature measured by the microsphere method (0.7–1.3 ml·min?1·g?1). In the early activated region during LV pacing, myocardial volume began to decrease before the LV pressure upstroke. We conclude that the volume change is greater than would be estimated from the known average transmural blood flow. This implies the existence of blood-filled spaces within the myocardium, which could communicate with the ventricular lumen. Our data in the early activated region also suggest that myocardial volume change is caused not by the intramyocardial tissue pressure but by direct impingement of the contracting myocytes on the microvasculature.

Ashikaga, Hiroshi; Coppola, Benjamin A.; Yamazaki, Katrina G.; Villarreal, Francisco J.; Omens, Jeffrey H.; Covell, James W.



Antioxidant enzymes attenuate myocardial stunning in the conscious dog  

SciTech Connect

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.

Triana, J.F.; Unisa, A.; Bolli, R. (Baylor Coll. of Medicine, Houston, TX (United States))



Relation between ST segment elevation during dobutamine stress test and myocardial viability after a recent myocardial infarction.  

PubMed Central

OBJECTIVE: To assess the relation between ST segment elevation during the dobutamine stress test and late improvement of function after acute Q wave myocardial infarction. PATIENTS AND DESIGN: 70 patients were studied a mean (SD) 8 (3) days after acute myocardial infarction with high dose dobutamine-atropine stress echocardiography and a follow up echocardiogram at 85 (10) days. A score model based on 16 segments and four grades was used to assess left ventricular function. Functional improvement was defined as a reduction of wall motion score > or = 1 in > or = 1 segments at follow up. INTERVENTION: Myocardial revascularisation was performed in 23 patients (33%) before follow up studies. RESULTS: ST segment elevation occurred in 40 patients (57%). Late functional improvement occurred in 35 patients (50%). Functional improvement was more common in patients with ST segment elevation (68% v 30%, P < 0.005) and they had a higher mean (SD) number of improved segments at follow up (1.9 (2.2) v 0.5 (1.1), P < 0.005). The wall motion score index decreased between baseline and follow up in patients with ST segment elevation (1.54 (0.50) v 1.48 (0.43), P < 0.05) but not in patients without ST segment elevation (1.39 (0.60) v 1.45 (0.47)). The accuracy of ST segment elevation for the prediction of functional improvement was similar to that of low dose dobutamine echocardiography in patients with anterior infarction (80% v 83%) and in patients who underwent revascularisation (78% v 83% respectively). CONCLUSION: In patients with a recent Q wave myocardial infarction, dobutamine-induced ST segment elevation is a valuable marker of myocardial viability particularly when the test is performed without or with suboptimal echocardiographic imaging.

Elhendy, A.; Cornel, J. H.; Roelandt, J. R.; van Domburg, R. T.; Geleijnse, M. I.; Nierop, P. R.; Bax, J. J.; Sciarra, A.; Ibrahim, M. M.; el-Refaee, M.; el-Said, G. M.; Fioretti, P. M.



Imaging myocardial strain  

Microsoft Academic Search

Measuring the local mechanical activity of the heart has lagged behind the measurement of electrical activity due to a lack of measurement tools. Myocardial wall motion abnormalities have been studied for years in the context of regional ischemia. Implanted beads and screws have been used to measure the mechanical activity of the heart in a few isolated regions. Over the

E. McVeigh; C. Ozturk



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

SciTech Connect

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.

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



Implications of ST-segment elevation in leads V5 and V6 in patients with reperfused inferior wall acute myocardial infarction.  


During inferior acute myocardial infarction, ST-segment elevation (ST?) often occurs in leads V(5) to V(6), but its clinical implications remain unclear. We examined the admission electrocardiograms from 357 patients with a first inferior acute myocardial infarction who had Thrombolysis In Myocardial Infarction 3 flow of the right coronary artery or left circumflex artery within 6 hours after symptom onset. The patients were divided according to the presence (n = 76) or absence (n = 281) of ST? >2 mm in leads V(5) and V(6). Patients with ST? in leads V(5) and V(6) were subdivided into 2 groups according to the degree of ST? in leads III and V(6): ST? in lead III greater than in V(6) (n = 53) and ST? in lead III equal to or less than in V(6) (n = 23). The perfusion territory of the culprit artery was assessed using the angiographic distribution score, and a mega-artery was defined as a score of ?0.7. ST? in leads V(5) and V(6) with ST? in lead III greater than in V(6) and ST? in leads V(5) and V(6) with ST? in lead III equal to or less than in V(6) were associated with mega-artery occlusion and impaired myocardial reperfusion, as defined by myocardial blush grade 0 to 1. Right coronary artery occlusion was most common (96%) in the former, and left circumflex artery occlusion was most common (96%) in the latter, especially proximal left circumflex occlusion (74%). Multivariate analysis showed that ST? in leads V(5) and V(6) with ST? in lead III greater than that in V(6) (odds ratio 4.81, p <0.001) and ST? in leads V(5) and V(6) with ST? in lead III equal or less than that in V(6) (odds ratio 5.96, p <0.001) were independent predictors of impaired myocardial reperfusion. In conclusion, ST? in leads V(5) and V(6) suggests a greater risk area and impaired myocardial reperfusion in patients with inferior acute myocardial infarction. Furthermore, comparing the degree of ST? in lead V(6) with that in lead III is useful for predicting the culprit artery. PMID:22078965

Kosuge, Masami; Ebina, Toshiaki; Hibi, Kiyoshi; Iwahashi, Noriaki; Morita, Satoshi; Endo, Mitsuaki; Maejima, Nobuhiki; Gouhara, Masaomi; Nagashima, Zenkou; Umemura, Satoshi; Kimura, Kazuo



Anterior Cervical Arachnoid Cyst  

PubMed Central

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.

Sharifi, Give



Anterior cervical arachnoid cyst.  


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

Rahimizadeh, Abolfazl; Sharifi, Give



Dobutamine-Induced Myocardial Ischemia and ST-Segment Elevation in Collateral-Dependent Myocardium.  


In patients with obstructive coronary artery disease, electrocardiographic (ECG) ST-segment elevation (STE) is frequently seen during dobutamine stress echocardiography (DSE) in leads overlying previous transmural left ventricular (LV) myocardial infarction. The mechanism of occasional STE during DSE in LV region with inducible myocardial ischemia and no previous myocardial infarction has not been well delineated. We retrospectively identified 28 adults (age 51 to 83 years [69 ± 8]; 82% men) with STE (>1 mm at ?80 ms after J point in ?2 contiguous leads without pathologic Q waves) and inducible myocardial ischemia in the same territory during DSE. STE occurred in inferior (n = 16), inferolateral (n = 8), anterior (n = 1), lateral (n = 2), or anterolateral (n = 1) leads and was associated with ischemic symptoms in 17 patients (61%). Inducible LV wall motion abnormality developed in LV segments corresponding to ECG STE in all patients. Coronary arteriography (within 1 week of the index DSE) showed severe luminal narrowing in the major epicardial coronary artery supplying the region with DSE STE and ischemia (90% to 99% in 9 patients [32%] and 100% in 19 patients [68%]). The ischemic region was supplied by ipsilateral (n = 4 [14%]), contralateral (n = 21 [75%]), or both ipsilateral and contralateral (n = 3 [11%]) collateral branches. In conclusion, dobutamine-induced ECG STE in LV segments with normal baseline wall motion is a highly reliable marker of viable collateral-dependent myocardium. PMID:23866734

Shirani, Jamshid; Pranesh, Shruthi; Menhaji, Kimia; Cotarlan, Vlad; Brofferio, Alessandra



The versatility of pectoralis major muscle and musculocutaneous flaps in the reconstruction of the oral cavity and of the anterior chest wall.  


Musculocutaneous flaps, allowing one stage reconstructions and reducing the stay in hospital and rehabilitation period, have revolutionised modern plastic surgery. Muscle flaps are a good alternative to provide adequate coverage of tissue losses but with limited scarring. The authors report their 5 year clinical experience in the reconstruction of oral cavity and chest wall defects using the pectoralis major as muscle or musculocutaneous flap. The preliminary data of an angiographic study, confirming the segmentation of the pectoralis major muscle into two subunits, each provided with its own vascular supply (mainly the clavicular and the sternocostal segment), are also presented. The short and long-term results confirm the excellent viability and versatility of the pectoralis major musculocutaneous and muscle flap. In particular the complications rate is so low that this procedure can be considered safe and reliable. PMID:7928147

Candiani, P; Campiglio, G L; Saccheri, S; Roviaro, G C


The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities  

PubMed Central

AIM—To evaluate the angiographic, myocardial perfusion, and wall motion abnormalities in patients with severe compared with mild worsening of regional function during dobutamine stress echocardiography (DSE) for evaluation of myocardial ischaemia.?METHODS—147 patients with significant coronary artery disease and new or worsening wall motion abnormalities during DSE were enrolled. Left ventricular function was evaluated using a 16 segment/4 grade score model where 1 = normal and 4 = dyskinesis. Simultaneous sestamibi SPECT myocardial perfusion imaging was performed in all patients.?RESULTS—Severe worsening of regional function (an increase in wall motion score of two grades or more in ? 1 segment) was detected in 37 patients, while 110 patients had mild worsening (an increase in wall motion score of no more than one grade in ? 1 segment). Patients with severe worsening of regional function had more stenotic coronary arteries (2.31 (0.8) v 1.97 (0.8) (mean (SD)) (p <0.05), a higher prevalence of left anterior descending coronary artery disease (95% v 73%) (p < 0.05), a higher resting wall motion score index (1.71 (0.42) v 1.51 (0.40) (p = 0.01), and more stress perfusion defects (3.8 (1.5) v 2.8 (1.5) (p < 0.001) compared with patients with mild worsening. Multivariate analysis identified the number of stress perfusion defects (p < 0.005, ?2 = 8.8) and the number of ischaemic segments on echocardiography (p < 0.05, ?2 = 4.3) as independent variables associated with severe worsening of regional function.?CONCLUSIONS—The grade of worsening of regional function during DSE predicts the underlying extent of myocardial perfusion abnormalities. The occurrence of severe worsening of regional function is associated with variables known to predict worse prognosis in patients with coronary artery disease.???Keywords: coronary artery disease; myocardial perfusion; ventricular function; echocardiography

Elhendy, A; van Domburg, R T; Bax, J; Poldermans, D; Nierop, P; Geleijnse, M; Roelandt, J



Should we establish a new protocol for the treatment of peripartum myocardial infarction?  


Peripartum myocardial infarction is a rare event that is associated with high mortality rates. The differential diagnosis includes coronary artery dissection, coronary artery thrombosis, vascular spasm, and stenosis. Our evaluation of 2 cases over a 5-year time period has led to a hypothesis that peripartum myocardial infarction is an immune-mediated event secondary to coronary endothelial sensitization by fetal antigen. In our patients, we supplemented standard medical therapy with immunotherapy consisting of corticosteroids, plasmapheresis, and intravenous immunoglobulin. Herein, we present our most recent case-that of a 29-year-old black woman (gravida V, para IV), 2 weeks postpartum with no relevant medical history. She presented with a 1-week history of chest pain. Initial electrocardiographic and cardiac biomarkers were consistent with acute coronary syndrome. Echocardiography revealed reduced systolic function with inferior-wall hypokinesis. Angiography revealed diffuse disease with occlusion of the left anterior descending coronary artery not amenable to revascularization. We were successful in treating the myocardial infarction without the use of catheter-based interventions, by modifying the immunologic abnormalities. Two cases do not make a protocol. Yet we believe that this case and our earlier case lend credence to the hypothesis that peripartum myocardial infarction arises from sensitization by fetal antigens. This concept and the immune-modifying treatment protocol that we propose might also assist in understanding and treating other inflammatory-disease states such as peripartum cardiomyopathy and standard acute myocardial infarction. All of this warrants further investigation. PMID:22740744

Houck, Philip D; Strimel, William J; Gantt, D Scott; Linz, Walter J



Should We Establish a New Protocol for the Treatment of Peripartum Myocardial Infarction?  

PubMed Central

Peripartum myocardial infarction is a rare event that is associated with high mortality rates. The differential diagnosis includes coronary artery dissection, coronary artery thrombosis, vascular spasm, and stenosis. Our evaluation of 2 cases over a 5-year time period has led to a hypothesis that peripartum myocardial infarction is an immune-mediated event secondary to coronary endothelial sensitization by fetal antigen. In our patients, we supplemented standard medical therapy with immunotherapy consisting of corticosteroids, plasmapheresis, and intravenous immunoglobulin. Herein, we present our most recent case—that of a 29-year-old black woman (gravida V, para IV), 2 weeks postpartum with no relevant medical history. She presented with a 1-week history of chest pain. Initial electrocardiographic and cardiac biomarkers were consistent with acute coronary syndrome. Echocardiography revealed reduced systolic function with inferior-wall hypokinesis. Angiography revealed diffuse disease with occlusion of the left anterior descending coronary artery not amenable to revascularization. We were successful in treating the myocardial infarction without the use of catheter-based interventions, by modifying the immunologic abnormalities. Two cases do not make a protocol. Yet we believe that this case and our earlier case lend credence to the hypothesis that peripartum myocardial infarction arises from sensitization by fetal antigens. This concept and the immune-modifying treatment protocol that we propose might also assist in understanding and treating other inflammatory-disease states such as peripartum cardiomyopathy and standard acute myocardial infarction. All of this warrants further investigation.

Houck, Philip D.; Strimel, William J.; Gantt, D. Scott; Linz, Walter J.



A new operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and videoscope-assisted surgery.  


The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). In patients with advanced gastric tube cancer, resection of the gastric tube should be considered, but currently available procedures are very invasive. In patients undergoing curative surgery for gastric tube cancer that has developed after reconstruction through the retrosternal route, the gastric tube is usually resected through a median sternotomy, followed by reconstruction with the colon. However, postoperative complications often occur and treatment outcomes remain poor. We developed a new surgical technique for gastric tube resection without performing a sternotomy in patients with gastric tube cancer who had previously undergone reconstruction through the retrosternal route. Our technique was used to treat two patients. Two Kirschner wires were passed subcutaneously through the anterior chest; the chest was lifted to extend the retrosternal space and secure an adequate surgical field. The stomach was separated from the surrounding tissue under videoscopic guidance. Total resection of the gastric tube was done. The retrosternal space was used to lift the jejunum. Roux-en-Y reconstruction was performed. Neither patient had suture line failure or surgical site infection. Their recovery was uneventful. Our surgical technique has several potential advantages including (i) reduced surgical stress; (ii) the ability to use the retrosternal space for reconstruction after gastric tube resection; and (iii) a reduced risk of serious infections such as osteomyelitis in patients with suture line failure. Our findings require confirmation by additional studies. PMID:18430112

Hosoya, Y; Hirashima, Y; Hyodo, M; Haruta, H; Kurashina, K; Saito, S; Zuiki, T; Yasuda, Y; Nagai, H



Intravascular ultrasound assessment of the association between spatial orientation of ruptured coronary plaques and remodeling morphology of culprit plaques in ST-elevation acute myocardial infarction.  


The aim of this study was to assess the association between the spatial location of plaque rupture and remodeling pattern of culprit lesions in acute anterior myocardial infarction (MI). Positive remodeling suggests a potential surrogate marker of plaque vulnerability, whereas plaque rupture causes thrombus formation followed by coronary occlusion and MI. Intravascular ultrasound (IVUS) can determine the precise spatial orientation of coronary plaque formation. We studied 52 consecutive patients with acute anterior MI caused by plaque rupture of the culprit lesion as assessed by preintervention IVUS. The plaques were divided into those with and without positive remodeling. We divided the plaques into three categories according to the spatial orientation of plaque rupture site: myocardial (inner curve), epicardial (outer curve), and lateral quadrants (2 intermediate quadrants). Among 52 plaque ruptures in 52 lesions, 27 ruptures were oriented toward the epicardial side (52%), 18 toward the myocardial side (35%), and 7 in the 2 lateral quadrants (13%). Among 35 plaques with positive remodeling, plaque rupture was observed in 21 (52%) on the epicardial side, 12 (34%) on the myocardial side, and 2 (6%) on the lateral side. However, among 17 plaques without positive remodeling, plaque rupture was observed in 6 (35%), 6 (35%), and 5 (30%), respectively (p = 0.047). Atherosclerotic plaques with positive remodeling showed more frequent plaque rupture on the epicardial side of the coronary vessel wall in anterior MI than those without positive remodeling. PMID:21892739

Kusama, Ikuyoshi; Hibi, Kiyoshi; Kosuge, Masami; Sumita, Shinnichi; Tsukahara, Kengo; Okuda, Jun; Ebina, Toshiaki; Umemura, Satoshi; Kimura, Kazuo



Anorexia nervosa and myocardial infarction.  


A 39-year-old woman with long-standing anorexia nervosa was admitted to our hospital because of extreme weakness and cachexia. During a hyperalimentation therapy, she developed chest pain, revealing the electrocardiogram and cardiac enzymes a myocardial infarction of the inferior wall. We suggest that anorexia nervosa does not 'protect' against coronary atherosclerosis, and that some of the cases of sudden death could be related to myocardial ischemia. PMID:7960253

García-Rubira, J C; Hidalgo, R; Gómez-Barrado, J J; Romero, D; Cruz Fernández, J M



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

PubMed Central

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.

Nakazone, Marcelo A.; Machado, Mauricio N.; Barbosa, Raphael B.; Santos, Marcio A.; Maia, Lilia N.



When heart goes "BOOM" to fast. Heart rate greater than 80 as mortality predictor in acute myocardial infarction  

PubMed Central

Many prospective studies established association between high heart rate and increased cardiovascular morbidity and mortality, independently of other risk factors. Heart rate over 80 beats per minute more often leads to atherosclerotic plaque disruption, the main step in developing acute coronary syndrome. Purpose was to investigate the incidence of higher heart rate levels in patients with anterior wall acute myocardial infarction with ST-segment elevation and the influence of heart rate on mortality. Research included 140 patients with anterior wall acute myocardial infarction with ST-segment elevation treated in Coronary Unit, Clinical Center Kragujevac in the period from January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Other risk factors were also followed to determine their connection with elevated heart rate. Results showed that the majority of patients survived (over 70%). In a total number of patients, more than 75% had a heart rate levels greater than 80 beats per minute. There was a significant difference in heart rate on addmision between survivors and patients who died, with a greater levels in patients with fatal outcome. Both, univariate and multivariate regression analysis singled out heart rate greater than 80 beats per minute as independent mortality predictor in these patients. Heart rate greater than 80 beats per minute is a major, independent risk factor for morbidity and important predictor of mortality in patients with acute myocardial infarction.

Davidovic, Goran; Iric-Cupic, Violeta; Milanov, Srdjan; Dimitijevic, Aleksandra; Petrovic-Janicijevic, Mirjana



Kinetics and imaging of /sup 111/In-labeled autologous platelets in experimental myocardial infarction  

SciTech Connect

The kinetics of accumulation and the external imaging patterns of /sup 111/In-labeled platelets infused in a dog model of left anterior descending coronary artery occlusion with reperfusion were studied. The effects of infarct age and regional residual myocardial blood flow upon platelet accumulation were quantified, and the capacity of /sup 111/In platelets to image the experimental infarction was evaluated qualitatively. The endocardial accumulation of /sup 111/In platelets occurred primarily in infarct zones with residual blood flow less than 0.6 times normal and was maximal (24.98 +/- 2.76 times normal) in the lowest blood flow zone (less than 0.1 times normal). Indium-111 platelet accumulation in the epicardium occurred in the regions with blood flow less than 0.6 times normal and was maximal (17.83 +/- 1.20 times normal) in the lowest blood flow zone (less than 0.1 times normal). The maximal endocardial and epicardial platelet accumulation occurred 24 hours after reperfusion and was significantly decreased at 48 hours. In vivo cardiac images revealed discrete areas of increased myocardial radioactivity uptake in the anterior wall of dogs 24 hours after reperfusion. All images 48 hours after reperfusion were negative. Thus, in the experimental setting, /sup 111/In platelets allow quantification of platelet accumulation after myocardial infarction at a tissue level and provide a noninvasive means of in vivo imaging of reperfused infarcted myocardium.

Laws, K.H.; Clanton, J.A.; Starnes, V.A.; Lupinetti, F.M.; Collins, J.C.; Oates, J.A.; Hammon, J.W. Jr.



Myocardial temperature variation: effect on regional function and coronary flow in dogs  

SciTech Connect

Incremental changes in the temperature (28-42.5/sup 0/C) of the anterior left ventricular wall in a canine, working, beating right heart bypass preparation (constant preload, afterload, and heart rate) were produced to measure the effect of regional temperature on myocardial function and blood flow. Circumferential-axis segment lengths were measured with sonomicrometry in both the temperature-varied, left-anterior descending coronary artery (LAD)-supplied myocardium and the normothermic (38/sup 0/C) circumflex-supplied myocardium. Fast thermistors (time constant <0.25 s) continuously monitored midmyocardial temperature in both areas. A Silastic loop with heat exchanger, thermistors, strain gauge, and flow probe was inserted into the LAD and allowed precise control of regional myocardial temperature. Nine-micron radiolabeled microspheres injected into left atrium were used to evaluate coronary flow and distribution. In six anesthetized dogs, relative to normothermic control (38/sup 0/C), regional systolic shortening decreased 42.2 +/- 10% at 41/sup 0/C and increased 23.3 +/- 6% at 31/sup 0/C. There was no significant change in coronary blood flow or distribution at the three temperatures. Pressure-length areas varied inversely with myocardial temperature. These data demonstrate that there is a reversible inverse relationship between midwall T and ventricular function when heart rate, preload, and afterload are controlled.

D'Ambra, M.N.; Magrassi, P.; Lowenstein, E.; Kyo, S.; Austen, W.G.; Buckley, M.J.; LaRaia, P.J.



Assessment of Regional Longitudinal Myocardial Strain Rate Derived from Doppler Myocardial Imaging Indexes in Normal and Infarcted Myocardium  

Microsoft Academic Search

Myocardial deformation properties may be characterized by regional strain rates (SRs) calculated from Doppler myocardial velocity data. In 10 control subjects and 12 patients with established transmural infarcts, longitudinal median segmental SR, strain, and myocardial velocity were analyzed and compared with the corresponding wall motion score. All segments in control subjects and normal segments in infarct patients showed no significant

Jens-Uwe Voigt; Martina F. Arnold; Matts Karlsson; Leila Hübbert; Tomasz Kukulski; Liv Hatle; George R. Sutherland



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

SciTech Connect

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.

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



Myocardial strain imaging based on three dimensional motion tracking  

Microsoft Academic Search

The decrease of myocardial wall motion, caused by changes in wall stiffness, often appears in the early stage of ischemic heart disease. Since the myocardium exhibits complex 3-D motion, 3-D assessment of the stiffness distribution is required for accurate diagnosis. Therefore, we propose novel methods to track 3-D motion using a 2-D phased array and to assess myocardial malfunction by

Naotaka Nitta; Tsuyoshi Shiina



Cardiovascular magnetic resonance tagging of the right ventricular free wall for the assessment of long axis myocardial function in congenital heart disease  

PubMed Central

Background Right ventricular ejection fraction (RV-EF) has traditionally been used to measure and compare RV function serially over time, but may be a relatively insensitive marker of change in RV myocardial contractile function. We developed a cardiovascular magnetic resonance (CMR) tagging-based technique with a view to rapid and reproducible measurement of RV long axis function and applied it in patients with congenital heart disease. Methods We studied 84 patients: 56 with repaired Tetralogy of Fallot (rTOF); 28 with atrial septal defect (ASD): 13 with and 15 without pulmonary hypertension (RV pressure > 40 mmHG by echocardiography). For comparison, 20 healthy controls were studied. CMR acquisitions included an anatomically defined four chamber cine followed by a cine gradient echo-planar sequence in the same plane with a labelling pre-pulse giving a tag line across the basal myocardium. RV tag displacement was measured with automated registration and tracking of the tag line together with standard measurement of RV-EF. Results Mean RV displacement was higher in the control (26 ± 3 mm) than in rTOF (16 ± 4 mm) and ASD with pulmonary hypertension (18 ± 3 mm) groups, but lower than in the ASD group without (30 ± 4 mm), P < 0.001. The technique was reproducible with inter-study bias ± 95% limits of agreement of 0.7 ± 2.7 mm. While RV-EF was lower in rTOF than in controls (49 ± 9% versus 57 ± 6%, P < 0.001), it did not differ between either ASD group and controls. Conclusions Measurements of RV long axis displacement by CMR tagging showed more differences between the groups studied than did RV-EF, and was reproducible, quick and easy to apply. Further work is needed to assess its potential use for the detection of longitudinal changes in RV myocardial function.



Coronary-Pulmonary Fistulas Involving All Three Major Coronary Arteries Co-Existing With Myocardial Infarction  

PubMed Central

We report the case of a man who presented with acute anterior myocardial infarction and in whom the coronary angiogram showed tight stenosis of the left anterior descending coronary artery and the right coronary artery associated with substantial coronary-pulmonary fistulas involving all three major coronary arteries. We discuss the possible links between coronary artery fistulas and myocardial infarction.

Dahdouh, Ziad; Lemaitre, Adrien; Sabatier, Remi; Lognone, Therese; Bignon, Mathieu; Malcor, Guillaume; Grollier, Gilles



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

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.

Ismailov, Rovshan M



[Cardiogenic embolisms following silent anterior wall infarct].  


A 33-year-old man had suffered recurrent arterial embolisms. Echocardiography identified as the most likely cause a large mobile mass in the left ventricle. Initially a primary heart tumor was discussed, but the ECG finding of an anterolateral scar and an angiographically proven LAD-stenosis were suspicious of an organized thrombus of the left ventricle. After surgical excision, histological analysis classified the mass as an organized thrombus. PMID:3751222

Bubenheimer, P; Grundler, D; Birnbaum, D



Local erythropoietin and endothelial progenitor cells improve regional cardiac function in acute myocardial infarction  

PubMed Central

Background Expanded endothelial progenitor cells (eEPC) improve global left ventricular function in experimental myocardial infarction (MI). Erythropoietin beta (EPO) applied together with eEPC may improve regional myocardial function even further by anti-apoptotic and cardioprotective effects. Aim of this study was to evaluate intramyocardial application of eEPCs and EPO as compared to eEPCs or EPO alone in experimental MI. Methods and Results In vitro experiments revealed that EPO dosed-dependently decreased eEPC and leukocyte apoptosis. Moreover, in the presence of EPO mRNA expression in eEPC of proangiogenic and proinflammatory mediators measured by TaqMan PCR was enhanced. Experimental MI was induced by ligation and reperfusion of the left anterior descending coronary artery of nude rats (n = 8-9). After myocardial transplantation of eEPC and EPO CD68+ leukocyte count and vessel density were enhanced in the border zone of the infarct area. Moreover, apoptosis of transplanted CD31 + TUNEL + eEPC was decreased as compared to transplantation of eEPCs alone. Regional wall motion of the left ventricle was measured using Magnetic Resonance Imaging. After injection of eEPC in the presence of EPO regional wall motion significantly improved as compared to injection of eEPCs or EPO alone. Conclusion Intramyocardial transplantation of eEPC in the presence of EPO during experimental MI improves regional wall motion. This was associated with an increased local inflammation, vasculogenesis and survival of the transplanted cells. Local application of EPO in addition to cell therapy may prove beneficial in myocardial remodeling.



Accuracy of localization of acute myocardial infarction by 12 lead electrocardiography  

SciTech Connect

Until recently, ECG accuracy in localizing acute myocardial infarction (AMI) could be assessed only by comparing the ECGs with autopsy findings. This approach, however, preselected patients, including only those who died. It is possible that this postmortem group of patients would be different from the whole population of patients with AMI. Myocardial imaging with /sup 99/mTc-pyrophosphate offers the advantage of directly localizing the region of injured myocardium in the acute phase of AMI. In 34 patients with confirmed AMI and focal uptake of /sup 99/mTc-pyrophosphate, serial ECGs were obtained and interpreted by two independent observers. The sensitivity and specificity of serial ECGs in determining the location of AMI in the five left ventricular (LV) wall segments were determined: (1) in the anterior wall sensitivity was 86.7% and specificity was 89.5%; (2) in the lateral wall sensitivity was 73.7% and specificity was 80.0%; (3) in the high lateral wall sensitivity was 80.0% and specificity was 87.5%; (4) in the inferior wall sensitivity was 87.5% and specificity was 100%; (5) in the true posterior wall sensitivity was 83.3% and specificity was 86.4%. Overall, in the 170 LV wall segments (five per patient) examined, scans localized with a sensitivity of 81.9% and a specificity of 88.8%. After four patients with LBBB were excluded, sensitivity increased to 87.1%. Overall, localization of AMI by serial ECG was accurate in 85.9% of the 34 patients included in the study.

Yasuda, T.; Ribeiro, L.G.; Holman, B.L.; Alpert, J.S.; Maroko, P.R.



[Neurologic complications of myocardial infarction].  


Investigated were 275 patients, 30 autopsies and 35 animals with experimental cardiac ischemia and myocardial infarction. Polymorphic neurological complications were detected among which most important were: 1. Cardiocerebral syndromes, crises, strokes; 2. Circulation disorders in anterior and posterior spinal, and posterior radicular arterial beds leading to cardio-spinal crises and spinal strokes; 3. Cardio-brachial, cardio-intercostal, radiculo-cardio-lumbo-sacral, cervico-thoracic, brachio-plantar, brachioscapular syndromes. PMID:2558472

Abdukhakimov, F T; Sadykova, G K



Preemptive heme oxygenase-1 gene delivery reveals reduced mortality and preservation of left ventricular function 1 yr after acute myocardial infarction.  


We reported previously that predelivery of heme oxygenase-1 (HO-1) gene to the heart by adeno-associated virus-2 (AAV-2) markedly reduces ischemia and reperfusion (I/R)-induced myocardial injury. However, the effect of preemptive HO-1 gene delivery on long-term survival and prevention of postinfarction heart failure has not been determined. We assessed the effect of HO-1 gene delivery on long-term survival, myocardial function, and left ventricular (LV) remodeling 1 yr after myocardial infarction (MI) using echocardiographic imaging, pressure-volume (PV) analysis, and histomorphometric approaches. Two groups of Lewis rats were injected with 2 x 10(11) particles of AAV-LacZ (control) or AAV-human HO-1 (hHO-1) in the anterior-posterior apical region of the LV wall. Six weeks after gene transfer, animals were subjected to 30 min of ischemia by ligation of the left anterior descending artery followed by reperfusion. Echocardiographic measurements and PV analysis of LV function were obtained at 2 wk and 12 mo after I/R. One year after acute MI, mortality was markedly reduced in the HO-1-treated animals compared with the LacZ-treated animals. PV analysis demonstrated significantly enhanced LV developed pressure, elevated maximal dP/dt, and lower end-diastolic volume in the HO-1 animals compared with the LacZ animals. Echocardiography showed a larger apical anterior-to-posterior wall ratio in HO-1 animals compared with LacZ animals. Morphometric analysis revealed extensive myocardial scarring and fibrosis in the infarcted LV area of LacZ animals, which was reduced by 62% in HO-1 animals. These results suggest that preemptive HO-1 gene delivery may be useful as a therapeutic strategy to reduce post-MI LV remodeling and heart failure. PMID:17322421

Liu, Xiaoli; Simpson, Jeremy A; Brunt, Keith R; Ward, Christopher A; Hall, Sean R R; Kinobe, Robert T; Barrette, Valerie; Tse, M Yat; Pang, Stephen C; Pachori, Alok S; Dzau, Victor J; Ogunyankin, Kofo O; Melo, Luis G



Myocardial Bridge  


... Cardiovascular Disease Diagnostic Tests and Procedures Ask a Texas Heart Institute Doctor: Search "myocardial bridge" Updated October ... Outside the U.S., call 1-832-355-6536.) Texas Heart Institute Heart Information Center Through this community ...


Myocardial viability.  

PubMed Central

Left ventricular function is a major predictor of outcome in patients with coronary artery disease. Acute ischemia, postischemic dysfunction (stunning), myocardial hibernation, or a combination of these 3 are among the reversible forms of myocardial dysfunction. In myocardial stunning, dysfunction occurs despite normal myocardial perfusion, and function recovers spontaneously over time. In acute ischemia and hibernation, there is regional hypoperfusion. Function improves only after revascularization. Evidence of myocardial viability usually relies on the demonstration of uptake of various metabolic tracers, such as thallium (thallous chloride TI 201) or fludeoxyglucose F 18, by dysfunctional myocardium or by the demonstration of contractile reserve in a dysfunctional region. This can be shown as an augmentation of function during the infusion of various sympathomimetic agents. The response of ventricular segments to increasing doses of dobutamine may indicate the underlying mechanism of dysfunction. Stunned segments that have normal perfusion show dose-dependent augmentation of function. If perfusion is reduced as in hibernating myocardium, however, a biphasic response usually occurs: function improves at low doses of dobutamine, whereas higher doses may induce ischemia and, hence, dysfunction. But in patients with severely impaired perfusion, even low doses may cause ischemia. Myocardial regions with subendocardial infarction or diffuse scarring may also have augmented contractility during catecholamine infusion due to stimulation of the subepicardial layers. In these cases, augmentation of function after revascularization is not expected. Because the underlying mechanism, prognosis, and therapy may differ among these conditions, it is crucial to differentiate among dysfunctional myocardial segments that are nonviable and have no potential to regain function, hibernating or ischemic segments in which recovery of function occurs only after revascularization, and myocardial stunning in which function is expected to recover spontaneously. Because combinations of all of these disorders may occur, even in the same segments, caution should be used in interpreting the imaging results.

Birnbaum, Y; Kloner, R A



Acute mitral valve regurgitation due to complete rupture of anterior papillary muscle mimicking mitral valve vegetation.  


We report the successful treatment of a 77-year-old man after a difficult diagnosis of mitral valve regurgitation resulting from complete rupture of the anterior papillary muscle. The patient with cardiogenic shock was an emergency admission. An electrocardiogram showed acute lateral wall myocardial infarction. He had complications of leukocytosis and a high-grade fever. Transesophageal echocardiography seemed to show the appearance of a large area of vegetation attached to the anterior mitral valve leaflet and aortic non-coronary cusp, resulting in severe mitral regurgitation. We performed coronary angiography, which showed complete obstruction of the circumflex coronary artery. We determined that the condition was caused by infective endocarditis. Emergency surgery showed the complete rupture of the anterior papillary muscle, but there was no vegetation. The mitral valve was replaced with a bioprosthetic valve and the circumflex coronary artery was bypassed with a saphenous vein graft. Pathological examination revealed mitral valve to be non-mycotic, and the postoperative course was uneventful. PMID:21587137

Takahashi, Yosuke; Tsutsumi, Yasushi; Monta, Osamu; Kato, Yasuyuki; Kohshi, Keitaro; Sakamoto, Tomohiko; Ohashi, Hirokazu



Scintigraphic assessment of sympathetic innervation after transmural versus nontransmural myocardial infarction  

SciTech Connect

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.

Dae, M.W.; Herre, J.M.; O'Connell, J.W.; Botvinick, E.H.; Newman, D.; Munoz, L. (University of California, San Francisco (USA))



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

SciTech Connect

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.

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



Autologous Cardiomyotissue Implant Promotes Myocardial Regeneration, Decreases Infarct Size and Improves Left Ventricular Function  

PubMed Central

Background Cell therapy for myocardial infarction (MI) may be limited by poor cell survival and lack of transdifferentiation. We report a novel technique of implanting whole autologous myocardial tissue from preserved myocardial regions into infarcted regions. Methods and Results Fourteen rats were used to optimize cardiomyotissue size using peritoneal wall implantation (300?M identified as optimal size). Thirty-nine pigs were used to investigate cardiomyotissue implantation in MI induced by LAD balloon occlusion [10 animals died, male to female transplantation for tracking with ISH for Y chromosome, n=4 (2-donors and 2-MI animals), acute MI implant cohort at 1 hour, n=13, and healed MI implant at 2 weeks, n=12]. Assessment included echocardiography, MRI, hemodynamics, TTC staining, histological, and molecular analysis. Tracking studies demonstrated viable implants with donor cells interspersed in the adjacent myocardium with gap junctions and desmosomes. In the acute MI cohort, treated animals compared to controls had improved perfusion by MRI (1.2±0.01 vs. 0.86±0.05,p<0.01), decreased MI size (MRI:%LV:2.2±0.5 vs. 5.4±1.5,p=0.04, TTC: %Anterior wall: 10.3±4.6 vs. 28.9±5.8,p<0.03), improved contractility (+dP/dt:1235±215 vs. 817±817,p<0.05). In healed MI cohort, treated animals had less decline in EF between 2 and 4 week assessment (-3±4% vs. -13±-4%,p<0.05), less decline in +/-dP/dt, and smaller MI (TTC: 21±11% vs. 3±8%,p=0.006) than control animals. Infarcts in the treated animals contained more mdr-1+ cells and fewer c-kit+ cells with a trend for decreased expression of MMP-2 and increased expression of TIMP-2. Conclusion Autologous cardiomyotissue implanted in myocardial infarction area remains viable, exhibits electromechanical coupling, decreases infarct size and improves LV function.

Wykrzykowska, Joanna J.; Rosinberg, Audrey; Lee, Seung U.; Voisine, Pierre; Wu, Guifu; Appelbaum, Evan; Boodhwani, Munir; Sellke, Frank W.; Laham, Roger J.



Assessment of Myocardial Scar; Comparison Between 18F-FDG PET, CMR and 99Tc-Sestamibi  

PubMed Central

Objective: Patients with heart failure and ischaemic heart disease may obtain benefit from revascularisation if viable dysfunctional myocardium is present. Such patients have an increased operative risk, so it is important to ensure that viability is correctly identified. In this study, we have compared the utility of 3 imaging modalities to detect myocardial scar. Design: Prospective, descriptive study. Setting: Tertiary cardiac centre. Patients: 35 patients (29 male, average age 70 years) with coronary artery disease and symptoms of heart failure (>NYHA class II). Intervention: Assessment of myocardial scar by 99Tc-Sestamibi (MIBI), 18F-flurodeoxyglucose (FDG) and cardiac magnetic resonance (CMR). Outcome Measure: The presence or absence of scar using a 20-segment model. Results: More segments were identified as nonviable scar using MIBI than with FDG or CMR. FDG identified the least number of scar segments per patient (7.4 +/? 4.8 with MIBI vs. 4.9 +/? 4.2 with FDG vs. 5.8 +/? 5.0 with CMR, p = 0.0001 by ANOVA). The strongest agreement between modalities was in the anterior wall with the weakest agreement in the inferior wall. Overall, the agreement between modalities was moderate to good. Conclusion: There is considerable variation amongst these 3 techniques in identifying scarred myocardium in patients with coronary disease and heart failure. MIBI and CMR identify more scar than FDG. We recommend that MIBI is not used as the sole imaging modality in patients undergoing assessment of myocardial viability.

Crean, Andrew; Khan, Sadia N.; Davies, L. Ceri; Coulden, Richard; Dutka, David P.



Natural evolution of left ventricular haemodynamics following uncomplicated acute myocardial infarction.  


In an attempt to investigate the changes in left ventricular haemodynamics following uncomplicated myocardial infarction 95 patients with definite electrocardiographic signs of infarction, without clinical signs of cardiac failure, were monitored with a Swan Ganz catheter for the first 24 hours after admission to hospital. The median delay from onset of symptoms was 6.8 hours. Mean heart rate increased (83-86 beats/min; P less than 0.05) while stroke volume index fell (38.4-36.6 ml/m2; P less than 0.05); cardiac index therefore remained unchanged during the observation period. As a result of a fall in arterial pressure both systemic vascular resistance and left ventricular stroke work index fell significantly (P less than 0.01). Pulmonary wedge pressure also fell (13.6-10.5 mm Hg; P less than 0.001), but this fall was confined to patients whose initial reading was above the median of 13 mm Hg. Pulmonary wedge pressure fell both among the 41 patients who required some medical therapy (15.6-10.8 mm Hg; P less than 0.001) and the 54 who received no medication throughout the 24 hours (12.0-9.8 mm Hg; P less than 0.05). The 39 patients with anterior wall infarction had higher baseline pulmonary wedge pressure and systemic vascular resistance than the 42 with inferior wall infarction. Later the stroke volume and stroke work index were persistently lower reflecting the greater degree of impairment of left ventricular function in anterior wall infarction. In conclusion, following an uncomplicated myocardial infarction, cardiac index was maintained, despite a fall in stroke volume, by an increase in heart rate. Pulmonary wedge pressure showed both a spontaneous fall and a fall in those patients given additional medical therapy during the study period. PMID:3710624

Murray, D P; Corbeij, H M; Dunselman, P H; Held, P H; Hjalmarson, A; Swedberg, K



Left systolic atrioventricular plane displacement in the assessment of myocardial viability in patients with previous myocardial infarction.  


In order to detect myocardial viability in coronary artery disease patients (CAD) with a previous myocardial infarction and dysfunction of the left ventricle (LV), the reliability of the left atrioventricular plane displacement (LAVPD) during low dose dobutamine stress echocardiography (DSE), was validated. The study population consisted of 70 CAD patients and 35 age and sex matched healthy subjects. From the apical four and two chamber views the LAVPD was recorded and measured by M-mode echocardiography, at four sites corresponding to the septal, lateral, anterior and inferior walls of the LV, prior and during the DSE (5-10 micrograms/kg/min). All patients underwent exercise SPECT Thallium-201 with four-hour redistribution and rest-reinjection, in order to determine tissue viability. Intraobserver and interobserver variability for the LAVPD was insignificant (5.8% and 7.2%, respectively). Healthy subjects exhibited a significant and equally distributed maximal increase of the LAVPD, at all sites during dobutamine infusion (DI) (p < 0.001). Patients also, showed a significant maximal increase of the LAVPD during DI, at all asynergic sites in which viable tissue was found (p < 0.001). However, in the asynergic sites without viable tissue the LAVPD did not significantly change (p < 0.05). Selecting a LAVPD increase of > 2 mm to detect viable myocardium at any asynergic site of LV, resulted in a sensitivity of 91% and specificity of 89%. When DSE was used for the detection of viable myocardium, sensitivity and specificity were found to be 80% and 87% respectively. The proportion of agreement between the two above mentioned methods was 82%. When the two methods were in agreement, the positive and negative predictive values were 94% and 97%, respectively. The validity of the above mentioned increase of the LAVPD was also prospectively examined in a similar group of 35 CAD patients exhibiting myocardial dysfunction as a result of a previous myocardial infarction (sensitivity 85% and specificity 90%, respectively). Conclusions: 1) The assessment of left LAVPD during DI is a new quantitative, accurate method with a low intraobserver and interobserver variability, in detecting viable myocardium. 2) Combination of this method and DSE proved good diagnostic markers of myocardial viability. PMID:8540270

Bouki, K; Kranidis, A; Kostopoulos, K; Rondogianni, F; Giannopoulou, H; Antonelis, J; Fehske, W; Tavernarakis, A; Kesse, M; Anthopoulos, L



Importance of Gated Imaging in Both Phases of Myocardial Perfusion SPECT: Myocardial Stunning After Dipyridamole Infusion  

Microsoft Academic Search

We present the case report of a 72-y-old woman who underwent 99mTc-sestamibi gated myocardial perfusion SPECT with a 2-d protocol. SPECT images revealed ischemia of the apical, anter- oapical, apicoseptal, and septal walls. Postdipyridamole gated SPECT revealed significant deterioration in the left ventricular ejection fraction (LVEF), wall motion, and systolic wall thickening relative to the findings obtained with rest gated

Vahidreza Dabbagh Kakhki; Seyed Rasoul Zakavi; Ramin Sadeghi; Ahmad Yousefi


Myocardial strain changes in Duchenne muscular dystrophy without overt cardiomyopathy  

Microsoft Academic Search

BackgroundPatients with Duchenne muscular dystrophy (DMD) are at risk of the development of dilated cardiomyopathy and heart failure, thus making early identification of high-risk patients necessary. Myocardial strain imaging (MSI) can be used for quantitative analysis of wall motion of the left ventricle (LV). The aim of this study was to determine whether MSI could detect early changes in myocardial

Hitoko Ogata; Satoshi Nakatani; Yuka Ishikawa; Akifumi Negishi; Michiko Kobayashi; Yukitoshi Ishikawa; Ryoji Minami



Left ventricular volumes, ejection fraction, and regional wall motion calculated with gated technetium-99m tetrofosmin SPECT in reperfused acute myocardial infarction at super-acute phase: Comparison with left ventriculography  

Microsoft Academic Search

Background  Noninvasive assessment of acute myocardial infarction (AMI) requires information about both myocardial perfusion and left\\u000a ventricular (LV) function. The automated quantification of electrocardiographic-gated myocardial scintigraphy with technetium-99m\\u000a tetrofosmin (QGS) can provide this information.\\u000a \\u000a \\u000a \\u000a Methods and Results  Coronary arteriography, QGS, and left ventriculography (LVG) were performed in 229 patients with reperfused AMI within 2 days\\u000a after onset. All infarcted vascular territories (229

Mitsunori Abe; Yukio Kazatani; Hiroshi Fukuda; Hironari Tatsuno; Hirokazu Habara; Hiroyuki Shinbata



Wall Motion Estimation for Gated Cardiac Emission Tomography: Physical Phantom Evaluation  

Microsoft Academic Search

The purpose of this work was to evaluate myocardial wall motion estimation methods for gated cardiac emission tomography using a dynamic, physical phantom. Wall motion has been increasingly used in 4D image reconstruction methods for improved image quality. A commercially available dynamic phantom was modified by attaching radioactive markers to the phantom myocardial wall. The markers were used to provide

Jason G. Parker; David R. Gilland



Fatal myocardial infarction in marathon racing.  


A 44-year-old trained marathon runner collapsed after completing 24 miles of the 1973 Boston Marathon. He was resuscitated from ventricular fibrillation. Death occurred after 50 days of coma. Extensive transmural anterior myocardial infarction was documented on electrocardiogram and proved at autopsy, yet the coronary arteries were free of significant atherosclerosis. We believe this report to be the first documentation of a myocardial infarction in a trained athlete while participating in a marathon. We emphasize that the relation between exertion and infarction is unknown. Advocates of long distance running for prevention of, or rehabilitation from, ischemic heart disease should be aware of this possible complication. PMID:937883

Green, L H; Cohen, S I; Kurland, G



Early administration of captopril and nitroglycerin in combination after acute myocardial infarction: an invasive haemodynamic study.  


The combination of captopril and nitroglycerin early after acute myocardial infarction (AMI) could lead to a dangerous decrease in blood pressure coronary perfusion. To evaluate the safety aspects and haemodynamic effects of this combination, we studied 36 first 'Q wave' thrombolysed anterior wall AMI patients during the 24 h following the onset of symptoms. Afterwards, thrombolysis patients received a continuous infusion of nitroglycerin and were submitted to pulmonary artery catheterization. Those patients with mean arterial pressure (MAP) > or = 70 mmHg, cardiac index > or = 2.2 l.min-1.m-2, and wedge pressure > or = 10 mmHg were included and randomized to receive 6.25 mg of captopril every 6 h on the first day and 12.5 mg qid on the second if MAP > or = 70 mmHg (group 1). A second group (group 2) received a placebo. Haemodynamic parameters were determined after 1, 6 and then every 6 h up to 48 h after basal measurements. Significant differences were observed only for the MAP and the rate-pressure product (reduction in group 1 values, P < 0.05). However, MAP was maintained within acceptable limits. Our data support the fact that the combination of captopril and nitroglycerin in the early hours of a non-complicated anterior wall AMI is safe, and could guarantee its use in large clinical trials to determine the effects on left ventricle remodelling and survival after AMI. PMID:8432299

Tranchesi Júnior, B; Santos, R D; Caramelli, B; Gebara, O; Barbosa, V; Bellotti, G; Pileggi, F



Effects on infarct size and left ventricular function of early intravenous injection of anistreplase in acute myocardial infarction. The APSIM Study Investigators.  


A total of 231 patients suffering from a first acute myocardial infarction were randomly allocated within 4 hours following the onset of symptoms either to anistreplase or anisoylated plasminogen streptokinase activator complex (APSAC), 30 U over 5 minutes, or to conventional heparin therapy, 5000 IU in bolus injection. Heparin was reintroduced in both groups 4 h after initial therapy at a dosage of 500 IU/kg per day. A total of 112 patients received anistreplase and 119 received heparin within a mean period of 188 +/- 62 min following the onset of symptoms. Infarct size was estimated from single photon emission computerized tomography and expressed in percentage of the total myocardial volume. The patency rate of the infarct-related artery was 77% in the anistreplase group and 36% in the heparin group (p less than 0.001). Left ventricular ejection fraction determined from contrast angiography was significantly higher in the anistreplase group than in the heparin group (6 absolute percentage point difference). A significant 31% reduction in infarct size was found in the anistreplase group (33% for the anterior wall infarction subgroup [p less than 0.05] and 16% for the inferior wall infarction subgroup, NS). A close inverse relation was found between the values of left ventricular ejection fraction and infarct size (r = -.73, p less than 0.01). In conclusion, early infusion of anistreplase in acute myocardial infarction produced a high early patency rate, a significant limitation of infarct size, and a significant preservation of left ventricular systolic function, mainly in the anterior wall infarctions. PMID:2182240

Bassand, J P; Bernard, Y; Lusson, J R; Machecourt, J; Cassagnes, J; Borel, E



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

SciTech Connect

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.

Karagoz, Tevfik; Celiker, Alpay [Hacettepe University, Faculty of Medicine, Section of Pediatric Cardiology (Turkey)], E-mail:, E-mail:; Cil, Barbaros; Cekirge, Saruhan [Hacettepe University, Faculty of Medicine, Department of Radiology (Turkey)



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


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-1? (IL-1?) 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

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



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

PubMed Central

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.

Bernhard, Stefan; Mohlenkamp, Stefan; Tilgner, Andreas



Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease.  


Coronary artery disease (CAD) has been suggested to alter coronary flow reserve (CFR; the ratio between hyperemic and baseline coronary flow velocities) not only in territories supplied by stenotic arteries but also in angiographically normal, remote regions. However, few data exist regarding the left anterior descending (LAD) coronary artery as the normal index artery. The influence of remote CAD on CFR of the angiographically normal LAD was evaluated with transthoracic Doppler ultrasound to measure CFR in the LAD during 90 seconds of venous adenosine infusion (140 microg/kg/min) in 122 subjects who were assigned to 1 group; group 1 comprised 49 controls without angiographically detectable CAD, and group 2 consisted of 73 patients with an angiographically normal LAD and remote CAD. Group 2 was divided into 4 subgroups: 16 patients with previous remote percutaneous coronary intervention (group 2A); 13 patients with significant remote stenosis (group 2B); 23 patients with previous remote myocardial infarction and percutaneous coronary intervention (group 2C); and 21 patients with previous remote myocardial infarction but no percutaneous coronary intervention (group 2D). CFR in the LAD was not significantly different in groups 1 and 2 (3.08 +/- 0.61 and 3.03 +/- 0.69, respectively, p = NS). Decreased ejection fraction and increased wall motion score index in patients with remote CAD (p < 0.00001) and multivessel CAD did not affect CFR in the LAD (group 2A 3.18 +/- 0.77; group 2B 3.05 +/- 0.65; group 2C 3.07 +/- 0.79; group 2D 2.86 +/- 0.50, respectively; F = 0.63, p = NS). In conclusion, CFR of an angiographically normal LAD is preserved in patients with remote CAD, even in the presence of previous remote myocardial infarction and wall motion abnormalities. PMID:15342286

Pizzuto, Francesco; Voci, Paolo; Mariano, Enrica; Puddu, Paolo Emilio; Spedicato, Patrizia; Romeo, Francesco



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

PubMed Central

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

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



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

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.

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.



Lateral Abdominal Wall Reconstruction  

PubMed Central

Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage.

Baumann, Donald P.; Butler, Charles E.



Kounis syndrome presenting as ST-segment elevation myocardial infarction following a hymenoptera (bee) sting  

Microsoft Academic Search

We described a patient presenting with acute myocardial infarction after sustaining a hymenoptera (bee) sting. Cardiac catheterisation confirmed significant intra-coronary thrombosis in the left anterior descending artery with minimal underlying plaque disease. A unifying diagnosis of Kounis syndrome secondary to hymenoptera envenomation was made. This is followed by a brief review of the pathophysiology of acute myocardial infarction in the

Jaspal S. Taggar; Timothy Watson; Kashif Musarrat; Teri Millane



Acute myocardial infarction in a patient with von Willebrand disease: pathogenetic dilemmas and therapeutic challenges.  


Acute myocardial infarction occurs very rarely in patients with von Willebrand disease, a hereditary bleeding disorder characterized by deficiency of von Willebrand factor. We report a 45-year-old woman with von Willebrand disease who presented with acute anterior myocardial infarction. Percutaneous coronary intervention with adjuvant antiplatelet and antithrombotic therapy was performed without significant bleeding complications. PMID:12368516

Arjomand, Heidar; Aquilina, Patrick; McCormick, Daniel



Effects of Nitroglycerin on Regional Myocardial Ischemia Induced by Atrial Pacing in Dogs  

Microsoft Academic Search

SUMMARY The exact mechanism or mechanisms by which nitroglycerin exerts its beneficial effect on pacing-induced regional myocardial ischemia has not been ellucidated previously. In an open-chest, anesthetized canine preparation a fixed, flow limiting stenosis was applied to the left anterior descend- ing (LAD) coronary artery and heart rate was increased by atrial pacing. Mass spectrometry was used to measure myocardial




Anterior cruciate ligament arthroplasty  

Microsoft Academic Search

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes an serine transfers. This coincided with a proposed patho logic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate

David A. Kieffer; Robert J. Curnow; Richard B. Southwell; William F. Tucker; Katherine K. Kendrick



Anterior femoroacetabular impingement  

Microsoft Academic Search

Anterior femoroacetabular impingement is a mechanical hip disorder defined as abnormal contact between the anterior acetabular rim and the proximal femur. The typical patient is a young man who practices a martial art that involves kicking. Mechanical groin pain is the main presenting symptom. Passive flexion and internal rotation of the hip replicates the pain. The range of internal rotation

Frédéric Laude; Thierry Boyer; Alexis Nogier



Anterior bony ankle impingement  

Microsoft Academic Search

Anterior bony ankle impingement results from osteophyte formation on the anterior edge of the distal tibia and\\/or neck of the talus, secondary to direct trauma during extreme or repetitive ankle dorsiflexion. It is common in ballet dancers, gymnasts, soccer players, football players, runners, and high jumpers. Typically, patients will complain of painful limitation of dorsiflexion, catching, and swelling in the

Brian G. Donley; Manuel Leyes



Myocarditis confirmed by biopsy presenting as acute myocardial infarction.  

PubMed Central

Two cases of acute myocardial infarction occurred in association with myocarditis, which was confirmed by biopsy. The first patient suffered an anteroseptal and the second patient an inferior wall myocardial infarction shortly after an acute viral illness. In both patients, coronary angiography showed normal coronary arteries, and right ventricular endomyocardial biopsy confirmed myocarditis. Histological abnormalities attributable to ischaemic heart disease were absent. The first patient's condition became stable after immunosuppressive treatment. Myocarditis resolved spontaneously within three months in the second patient. Coronary artery spasm and myocardial involvement with a systemic disease were unlikely. Endomyocardial biopsy in patients with acute myocardial infarction and normal coronary arteries may be useful in identifying myocarditis associated with myocardial necrosis. Myocarditis in acute myocardial infarction in the absence of coronary artery obstruction has not previously been documented during life. Images

Costanzo-Nordin, M R; O'Connell, J B; Subramanian, R; Robinson, J A; Scanlon, P J



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

PubMed Central

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 (?) were measured and averaged. Mean fiber angles progressed nearly linearly from ?41° (SD 11) at the epicardium to +42° (SD 16) at the endocardium. Two families of sheets were identified at approximately +45° (?+) and ?45° (??). In the lateral region (n = 5), near the epicardium, sheets belonged to the ?+ family; in the midwall, to the ?? family; and near the endocardium, to the ?+ family. This pattern was reversed in the basal anterior region (n = 4). Sheets were uniformly ?? 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.

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



Bilateral anterior shoulder dislocation  

PubMed Central

Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side. Prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome.

Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek



Clinical-Echocardiographic Correlation of Myocardial Infarction with Extension to Right Chambers.  


In order to determine the transesophageal echocardiographic characteristics in patients with acute myocardial infarction of right ventricle and establish the relationship between these findings, the clinical condition, and their prognostic value, 38 patients consecutively admitted to the Instituto Nacional de Cardiología with a diagnosis of acute left ventricular myocardial infarction with extension to right ventricle and/or atrium were retrospectively studied. Of the left ventricular infarctions, 37 were posteroinferior and one anterior. Significant elevations of CPK and DHL were found in 35. In 30 patients (78%) electrocardiographic evidence of extension of infarction to the right ventricle was found, and in 3, evidence of right atrial infarction. Twenty-one patients presented clinical data compatible with right ventricular infarction. In 19, cardiac rhythm and atrioventricular conduction disturbances were documented. Coronary angiograms practiced on 34 patients demonstrated single-vessel (right coronary) disease in 12, affection of two vessels in 14, and lesions in three or more in 6. Coronary arteries presented no significant lesions in two cases. With TEE, alterations of right ventricular segmental mobility were demonstrated in all patients, and in 6, alterations of right atrial mobility as well. As respects the ventricular wall movement index, 68.5% had total scores (RV + LV) of <5. The other 31.5% had scores >/= 5. In 26%, the right ventricular wall movement index was >/=4. The RVDD/LVDD ratio was 1 or less in 30 patients (78%) and >1 in only 8 (22%). The conclusions from these findings are that: (1) TEE is an excellent diagnostic means of identifying right ventricular and/or atrial infarction; and (2) a relationship exists between the magnitude of right ventricular damage and a wall movement index of 5 or more or an RV/LV diastolic diameter ratio > 1:postinfarction hemodynamic deterioration is significantly greater and the incidence of intrahospitalary complications higher. PMID:11175028

Vargas-Barrón, Jesús; Espinola-Zavaleta, Nilda; Romero-Cárdenas, Angel; Simon-Ruiz, Silvino; Keirns, Candace; Peña-Duque, Marco; Rijlaarsdam, María; Lupi-Herrera, Eulo



Nitrates in myocardial infarction.  


Until two decades ago nitroglycerin was contraindicated in acute myocardial infarction (MI). Studies in the canine model demonstrated that low-dose intravenous (i.v.) infusion, carefully titrated to decrease mean blood pressure by 10% but not below 80 mmHg, during early stages of acute MI produced marked reduction of left ventricular (LV) preload, improvement in regional perfusion, and limitation of infarct size and remodeling. However, more i.v. nitroglycerin to decrease blood pressure further resulted in a paradoxical J-curve effect, with hypoperfusion and increased infarct size. Clinical studies have confirmed that low-dose i.v. nitroglycerin infusion for the first 48 hours after acute MI is safe, not only for improving performance in LV failure, but also for limiting ischemic injury, infarct size, remodeling, and infarct-related complications, including deaths in-hospital and up to 1 year. Recent studies suggest that more prolonged therapy with nitrates spanning the healing phase of acute anterior Q-wave MI can further limit LV remodeling and preserve function. Preliminary results of the recently completed ISIS-4 megatrial suggest, however, that long-term nitrate in patients with suspected MI in the 1990s does not improve survival significantly. PMID:7848898

Jugdutt, B I



Atherosclerosis and myocardial bridging: Not a benign combination. An autopsy case report  

PubMed Central

Myocardial bridging is a congenital coronary anomaly with a variety of clinical manifestations. Traditionally, myocardial bridging has been considered a benign condition, but some cases of myocardial ischemia, infarction and sudden cardiac death due to myocardial bridging have been reported. Various studies have suggested that in their intramyocardial segments, these vessels are protected from obstructive atherosclerosis, with atherosclerosis being present in the proximal part of the artery. We report a case in a 45-year-old male who had a 2.5-cm long myocardial bridging over the left anterior descending artery, with obstructive atherosclerosis being present in the proximal as well as the intramyocardial part (part of the artery below the myocardial bridge). Atherosclerosis occurring in the intramyocardial segment is a rare occurrence, and combined with systolic narrowing by the myocardial bridge can lead to ischemia of the cardiac musculature.

Thej, M. J.; Kalyani, R.; Kiran, J.



Myocyte injury along myofibers in left ventricular remodeling after myocardial infarction  

PubMed Central

Left ventricular (LV) remodeling following myocardial infarction (MI) is considered to contribute to cardiac dysfunction. Though myofiber organization is a key component of cardiac structure, functional and anatomical features of injured myofiber during LV remodeling have not been fully defined. We investigated myocyte injury after acute MI in a mouse model. Mice were subjected to surgical coronary occlusion/reperfusion by left anterior descending coronary artery (LAD) ligation and examined at 1 week and 4 weeks post-MI. Magnetic resonance imaging (MRI) analysis demonstrated a significant decrease in systolic regional wall thickening (WT) in the border and remote zones at 4 weeks post-MI compared to that at 1 week post-MI (?86% in border zone, P<0.05, and ?77% in remote zone, P<0.05). Histological assays demonstrated that a broad fibrotic scar extended from the initial infarct zone to the remote zone along midcircumferential myofibers. Of particular note was the fact that no fibrosis was found in longitudinal myofibers in the epi- and endomyocardium. This pattern of the scar formation coincided with the helical ventricular myocardial band (HVMB) model, introduced by Torrent-Guasp. MRI analysis demonstrated that the extension of the fibrotic scar along the band might account for the progression in cardiac dysfunction during LV remodeling.

Kusakari, Yoichiro; Xiao, Chun-Yang; Himes, Nathan; Kinsella, Stuart D.; Takahashi, Masaya; Rosenzweig, Anthony; Matsui, Takashi



The frequency, etiology, and significance of septal involvement in acute inferior myocardial infarction  

SciTech Connect

Involvement of the interventricular septum (IVS) in acute myocardial infarction is usually attributable to proximal left anterior descending artery (pLAD) occlusion; however, the IVS is also supplied by the posterior descending branch of the right coronary artery (RCA). Therefore, the authors investigated the frequency and significance of IVS involvement in acute inferior myocardial infarction (IMI) in 34 consecutive patients with IMI using thalium-201 scintigraphy (Tl-201), radionuclide ventriculography (RNV) and coronary angiography. Tl-201 perfusion defects of the IVS were found in 16 pts (Group 1), 11 of whom also had an IVS wall motion (WM) abnormality. In all 18 patients with normal IVS Tl-201 uptake (Group 2), IVS WM was also normal. IMI was due to RCA thrombosis in all 16 (100%) pts in Group 1 but in only 11 (61%) of the pts in Group 2; the remaining 7 had circumflex thrombosis. The frequencies of multiple-vessel disease and pLAD stenosis were similar in Group 1 and in Group 2 (81% vs 78% and 31% vs 33%, respectively). The authors conclude that IVS involvement in acute IMI 1) is frequent (47%), 2) appears to result from RCA thrombosis and cannot be attributed to pLAD disease, and 3) is associated with greater RV dysfunction.

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



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

SciTech Connect

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.

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



Atropine Dose in Acute Myocardial Infarction in Man  

Microsoft Academic Search

Heart rate response to intravenous atropine therapy in acute myocardial infarction (MI) was assessed from detailed studies performed on 18 of 492 consecutively admitted coronary care unit patients. Atropine was given for extreme bradycardia ( < 40\\/min) or bradycardia ( < 60\\/min) coincident with hypotension or ventricular premature beats. 14 patients had posterior and 4 anterior infarction. Degree of cardioacceleration

Michael D. Klein; Judy Barret; Thomas J. Ryan; Athan P. Flessas



Limitation of myocardial infarct size and preservation of left ventricular function by early administration of APSAC in myocardial infarction.  


In cases of acute myocardial infarction (MI), it has been shown that preserving left ventricular function and limiting infarct size with early reperfusion of the occluded artery by means of a thrombolytic agent could eventually result in a reduced mortality rate. The aim of the APSIM study (anisoylated plasminogen streptokinase activator complex [APSAC] dans l'infarctus du Myocarde) was to demonstrate that early administration of APSAC in patients with recent acute MI could limit the infarct size and preserve left ventricular systolic function. In all, 231 patients with a first acute MI were randomly allocated to either APSAC (30 U over 5 minutes) or to conventional heparin therapy (5,000 IU in bolus injection) within 5 hours of the onset of symptoms. Of these patients, 112 received APSAC and 119 received heparin within a mean period of 188 +/- 62 minutes after the onset of symptoms. The patency rate of the infarct-related artery was 77% in the APSAC group and 36% in the heparin group (p less than 0.001). Left ventricular ejection fraction determined from contrast angiography was significantly higher in the APSAC than in the heparin group. This was true for the entire population (0.53 +/- 0.13 vs 0.47 +/- 0.13, p = 0.002) as well as for the subgroups of anterior and inferior wall infarctions (0.47 +/- 0.13 vs 0.4 +/- 0.16, p = 0.004 and 0.56 +/- 0.11 vs 0.51 +/- 0.09, p = 0.02). At 3 weeks, the difference remained significant for patients with anterior MI.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2662738

Bassand, J P; Machecourt, J; Cassagnes, J; Lusson, J R; Borel, E; Schiele, F



Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography  

Microsoft Academic Search

Positron emission tomography has been shown to distinguish between reversible and irreversible ischemic tissue injury. Using this technique, 13 patients with acute myocardial infarction were studied within 72 hours of onset of symptoms to evaluate regional blood flow and glucose metabolism with nitrogen (N)-13 ammonia and fluorine (F)-18 deoxyglucose, respectively. Serial noninvasive assessment of wall motion was performed to determine

Markus Schwaiger; Richard Brunken; Maleah Grover-McKay; Janine Krivokapich; John Child; Jan H. Tillisch; Michael E. Phelps; Heinrich R. Schelbert



Myocardial Infarction Research Unit.  

National Technical Information Service (NTIS)

The interdisciplinary program has been concerned with basic mechanisms involved in acute myocardial infarction in the experimental setting, and with the natural history and therapy of acute myocardial infarction in man. The laboratory program has devised ...

J. Ross



Myocardial Infarction Research Unit.  

National Technical Information Service (NTIS)

Clinical and laboratory investigations are conducted to provide a better understanding and more effective treatment of myocardial infarction. Patients with acute myocardial infarction are carefully characterized by clinical, hemodynamic, electrophysiologi...

C. E. Rackley



Myocardial ischemia during sleep  

Microsoft Academic Search

The role of sleep in the pathogenesis of coronary ischaemic events such as myocardial infarction, transient myocardial ischaemia, or cardiac sudden death, is unclear. This review will analyse the available data on the subject according to: (i) the autonomic and cardiovascular changes during sleep that may potentially favour myocardial ischaemia; (ii) the evidence of a circadian distribution of coronary events;

Maria R. Bonsignore; Salvatore Smirne; Oreste Marrone; Giuseppe Insalaco; Adriana Salvaggio; Giovanni Bonsignore



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

SciTech Connect

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.

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



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

PubMed Central

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.

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



Medullary ventrolateral nitric oxide mediates the cardiac effect of electroacupuncture at "Neiguan" acupoint on acute myocardial ischemia in rats.  


Experiments were performed on male Sprague-Dawley (SD) rats anesthetized with a mixture of urethane and chloralose. A rat model of acute myocardial ischemia (AMI) was made by ligation of the left anterior descending branch of the coronary artery (LAD). After the LAD ligation, the ischemia area of the left ventricular wall became somewhat pale immediately. Under a light microscope, the pathological examination revealed that all the cells were swollen and in red color when the cardiac section was stained with hematoxylin basic fuchsin picric acid (HBFP), which indicated a typical change in the myocardial ischemia. In the AMI model, it was found that cardiac functions were markedly attenuated, such as decreases in the heart rate (HR), mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), maximal rate for left ventricular pressure rising and declining (+/-dp/dt(max)), velocity of contractile element (V(CE)) and total area of cardiac force loop (L(0)), and an increase in the left ventricular end diastolic pressure (LVEDP). In such AMI rats, application of electroacupuncture (EA) at "Neiguan" acupoints (Pe 6) for 20 min could obviously improve the above-mentioned cardiac functions. After microinjection of nitro-L-arginine (L-NNA), an inhibitor of nitric oxide synthase (NOS), was made into the rostral ventrolateral medulla (RVLM), the curative effect of EA on myocardial ischemia was reduced significantly or abolished, while after microinjection of normal saline of the same volume was made into the RVLM, the improving effect of EA remained. These results suggest that the effect of EA on myocardial ischemia is possibly mediated by the nitric oxide (NO) in the RVLM. PMID:15322687

Lu, Juan-Xiu; Zhou, Pei-Hua; Wang, Jin; Li, Xia; Cao, Yin-Xiang; Zhou, Xu; Zhu, Da-Nian



Implantation of a three-dimensional fibroblast matrix improves left ventricular function and blood flow after acute myocardial infarction.  


This study was designed to determine if a viable biodegradable three-dimensional fibroblast construct (3DFC) patch implanted on the left ventricle after myocardial infarction (MI) improves left ventricular (LV) function and blood flow. We ligated the left coronary artery of adult male Sprague-Dawley rats and implanted the 3DFC at the time of the infarct. Three weeks after MI, the 3DFC improved LV systolic function by increasing (p < 0.05) ejection fraction (37 +/- 3% to 62 +/- 5%), increasing regional systolic displacement of the infarcted wall (0.04 +/- 0.02 to 0.11 +/- 0.03 cm), and shifting the passive LV diastolic pressure volume relationship toward the pressure axis. The 3FDC improved LV remodeling by decreasing (p < 0.05) LV end-systolic and end-diastolic diameters with no change in LV systolic pressure. The 3DFC did not change LV end-diastolic pressure (LV EDP; 25 +/- 2 vs. 23 +/- 2 mmHg) but the addition of captopril (2mg/L drinking water) lowered (p < 0.05) LV EDP to 12.9 +/- 2.5 mmHg and shifted the pressure-volume relationship toward the pressure axis and decreased (p < 0.05) the LV operating end-diastolic volume from 0.49 +/- 0.02 to 0.34 +/- 0.03 ml. The 3DFC increased myocardial blood flow to the infarcted anterior wall after MI over threefold (p < 0.05). This biodegradable 3DFC patch improves LV function and myocardial blood flow 3 weeks after MI. This is a potentially new approach to cell-based therapy for heart failure after MI. PMID:19558777

Thai, Hoang M; Juneman, Elizabeth; Lancaster, Jordan; Hagerty, Tracy; Do, Rose; Castellano, Lisa; Kellar, Robert; Williams, Stuart; Sethi, Gulshan; Schmelz, Monika; Gaballa, Mohamed; Goldman, Steven



Upwardly concave ST segment morphology is common in acute left anterior descending coronary occlusion  

Microsoft Academic Search

ST elevation (STE) in anterior precordial leads, in association with upwardly convex morphology (M) or straightM, is associated with anterior acute myocardial infarction (aAMI). Upwardly concaveM is characteristic of pseudoinfarction patterns such as early repolarization. A retrospective review was done of diagnostic electrocardiograms (EKG) of consecutive patients presenting to our Emergency Department (ED) who underwent emergent primary percutaneous intervention (PCI)

Stephen W. Smith



Myocardial imaging. Coxsackie myocarditis  

SciTech Connect

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.

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



Anterior tibial striations.  


Radiolucent horizontal striations of the anterior cortex of the tibia were seen in 10 athletes who were evaluated for "shin-splints." There were seven basketball players, two professional dancers, and one hurdler. Each patient's history included vigorous leaping in performance of athletic feats. All the lesions were similar in location and appearance and were accompanied by thickening of the anterior tibial cortex. These striations are considered stress fractures and were not observed in a group of runners who were evaluated for shin-splints. PMID:6331753

Daffner, R H



Myocardial damage following transthoracic direct current countershock in newborn piglets  

SciTech Connect

The effect of transthoracic direct current countershock on the myocardium of 21 newborn piglets was studied. Myocardial damage was quantified by measuring the myocardial uptake of technetium-99m pyrophosphate injected 24 hours after countershock. Substantial myocardial damage occurred in animals given greater than 150 joules/kg but not at lower energy doses. Damage occurred in both ventricular free walls, but more frequently in the right ventricle. The epicardial half of the myocardium was more severely affected than the endocardial half. The relationship between myocardial damage and total countershock energy dose was well modeled by an exponential function. Transthoracic direct current countershock appears unlikely to cause myocardial damage in newborn piglets unless greatly elevated energy doses are employed.

Gaba, D.M.; Talner, N.S.



Silent inferior myocardial infarction with extensive right ventricular scarring.  


Right ventricular infarction (RVI) occurs in approximately 50% of patients with inferior myocardial infarction (MI). The assessment of RVI is important for identifying patients being at increased risk of in hospital mortality and poorer prognosis if impaired right ventricular (RV) systolic function is present. We report the case of an asymptomatic 38-year-old male who sustained a silent inferior myocardial infarction with extensive RV involvement. There was no history of myocardial ischemia and cardiovascular risk factors. Therefore, first cardiac magnetic resonance (CMR) imaging using delayed enhancement (DE) was performed and revealed a transmural inferior wall myocardial infarction of LV with extensive involvement of RV. This case illustrates the difficulties of conventional imaging modalities and invasive coronary angiography to depict an inferior myocardial infarction with RV involvement. PMID:17643510

Manka, Robert; Fleck, Eckart; Paetsch, Ingo



[Intramural anterior interventricular artery. Anatomical study].  


In an anatomical study of 187 patients who had died from various heart disorders, the anterior descending artery (ADA) had an intra-mural course in 33 cases (17.65 p. 100). This abnormal course had had no correlation with the sex of the patients, the nature of the disease, length of the trunk of the left coronary artery, and to the relative sizes of the coronary vascular supply on the right and the left. It is associated, to a degree which may reach statistical significance, with certain abnormalities of distrubution of the ADA itself, of other pericardial arteries, and with a particularly short course which means that it does not reach the apex of the heart in more than a third of cases. The anatomical position of the intraparietal segment appears to be remarkably constant, and several anatomical landmarks (the origin of the second anterior septal artery and of the second diagonal artery, both collaterals of the anterior descending artery) may lead one to suspect the presence of an anomaly in the course of the artery when the coronary arteriogram is doubtful. The thickness of the muscular bridge is variable, but is not as a rule great. The most constant anatomical finding is that the anterior descending artery, in its intra-parietal segment, maintains a thin wall, and is never the seat of atheromatous deposits, whatever the age of the patient. PMID:413516

Penther, P; Blanc, J J; Boschat, J; Granatelli, D



Anterior internal impingement  

Microsoft Academic Search

Purpose: The source of pain in patients with a stable shoulder and clinical signs of impingement is traditionally thought to be subacromial or outlet impingement, as popularized by Neer. This report introduces the concept of anterior internal impingement in patients with signs and symptoms of classic impingement syndrome and arthroscopic evidence of articular-side partial rotator cuff tear. Contact that occurs

Steven Struhl



Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction  

PubMed Central

OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for near-normal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a management strategy.

Schnell, Gregory B; Kryski, Albert J; Mann, Luana; Anderson, Todd J; Belenkie, Israel



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

PubMed Central

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.

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



Effect of wenxin granule on ventricular remodeling and myocardial apoptosis in rats with myocardial infarction.  


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

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



Simultaneous technetium-99m MIBI angiography and myocardial perfusion imaging  

SciTech Connect

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.

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



Regional myocardial perfusion of cardioplegic solutions  

SciTech Connect

We compared the regional myocardial perfusion of blood cardioplegic solution (BCP) and crystalloid cardioplegic solution (CCP) in 14 mongrel dogs. Cardiopulmonary bypass was established at 28 degrees C, and a hydraulic occluder was placed around the proximal left anterior descending (LAD) coronary artery. In group 1 (N = 7) collateral coronary arteries were ligated; in group 2 (N = 7) collateral coronary arteries were left in situ. After the aorta was clamped, BCP and CCP were alternately perfused at 200 ml/min. The occluder was inflated to produce moderate, severe, and critical LAD stenosis, and regional perfusion was measured by xenon-133 washout with the Silicon Avalanche Radiation Detector. BCP infusion produced a consistently higher aortic pressure, but CCP flow was better than BCP flow under all conditions, particularly without coronary collaterals. Regional myocardial perfusion of CCP is superior to BCP.

Eugene, J.; Lyons, K.P.; Ott, R.A.; Gelezunas, V.L.; Chang, C.W.; Kowall, M.G.; Haiduc, N.J.



Early and Delayed Myocardial Enhancement in Myocardial Infarction Using Two-Phase Contrast-Enhanced Multidetector-Row CT  

PubMed Central

Objective The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). Materials and Methods Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. Results After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). Conclusion Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.

Kim, Young-Whan; Han, Seong-Wook; Seo, Joon-Beom



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

SciTech Connect

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.

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



Abdominal wall gossypiboma.  


A 71-year-old woman, one year following a fleur-de-lis abdominoplasty and incisional hernia repair, presented with two chronic, draining peri-umbilical sinuses. Her immediate postoperative course was complicated by a superficial surgical site infection with central skin breakdown that was treated with vacuum assisted closure (VAC). After the wound had closed completely, two midline sinus tracts developed. A CT scan demonstrated an 8x3x1.6cm thick-walled collection along the anterior abdominal wall containing numerous air bubbles. Surgical debridement revealed a cavity containing an 8x3x1.6cm block of well incorporated VAC foam. With the increasing clinical use of VAC wound therapy, this image serves as an important reminder to include gossypiboma in the differential diagnosis for patients with chronic wound problems who have previously received VAC treatment. PMID:19683975

Huston, Tara L; Grant, Robert T



Effects of preinfarction angina pectoris on infarct size and in-hospital mortality after coronary intervention for acute myocardial infarction  

Microsoft Academic Search

We studied the effect of preinfarction angina on in-hospital outcomes after percutaneous coronary intervention for anterior and nonanterior acute myocardial infarction. Beneficial effects of preinfarction angina on infarct size and in-hospital outcome are evident in patients with anterior infarction, but not in those with nonanterior infarction.

Masami Kosuge; Kazuo Kimura; Sunao Kojima; Tomohiro Sakamoto; Masaharu Ishihara; Yujiro Asada; Chuwa Tei; Shunichi Miyazaki; Masahiro Sonoda; Kazufumi Tsuchihashi; Masakazu Yamagishi; Yoshihiko Ikeda; Mutsunori Shirai; Hisatoyo Hiraoka; Takeshi Inoue; Fumio Saito; Hisao Ogawa



Reverse left ventricular remodeling after acute myocardial infarction: the prognostic impact of left ventricular global torsion.  


Reverse left ventricular (LV) remodeling (>10 % reduction in LV end-systolic volume) may occur in patients recovering for acute ST-elevation myocardial infarction (STEMI), undergoing percutaneous revascularization of infarct-related coronary artery (PCI). To detect whether LV global torsion obtained by two-dimensional speckle-tracking echocardiography was predictive of reverse LV remodeling, 75 patients with first anterior wall STEMI were studied before (T1) and after PCI (T2) and at 6-month follow-up. Two-year clinical follow-up was also accomplished. LV volumes and both LV sphericity index and conic index were obtained by three-dimensional echocardiography. Reverse remodeling was observed in 25 patients (33 %). By multivariate analysis, independent predictors of reverse LV remodeling were: LV conic index, T2 LV torsion and ? torsion (difference between T2 and T1 LV torsion expressed as percentage of this latter). According to receiver operating characteristic analysis, 1.34°/cm for T2 LV torsion (sensitivity 88 % and specificity 80 %) and 54 % for ? torsion (sensitivity 92 % and specificity 82 %) were the optimal cutoff values in predicting reverse LV remodeling. In up to 24 month follow-up, 4 non-fatal re-infarction, 7 hospitalization for heart failure and 4 cardiac deaths occurred. By multivariate Cox analysis, the best variable significantly associated with event-free survival rate was reverse LV remodeling with a hazard ratio = 9.9 (95 % confidence interval, 7.9-31.4, p < 0.01). In conclusion, reverse LV remodeling occurring after anterior wall STEMI is associated with favorable long-term outcome. The improvement of global LV torsion following coronary artery revascularization is the major predictor of reverse LV remodeling. PMID:23179752

Spinelli, Letizia; Morisco, Carmine; Assante di Panzillo, Emiliano; Izzo, Raffaele; Trimarco, Bruno



Symptomatic Enlarged Cervical Anterior Epidural Venous Plexus in a Patient with Marfan Syndrome  

Microsoft Academic Search

Summary: A 38-year-old man with Marfan syndrome pre- sented with headache and neck pain. MR imaging revealed a large enhancing mass in the cervical anterior epidural space. Cervical laminectomy with biopsy of the lesion revealed a large engorged anterior epidural venous plexus (AEVP). Marfan syndrome may predispose the patient to enlargement of AEVP secondary to a vessel wall abnormality. Marfan

Jay Y. Chun; William P. Dillon; Mitchel S. Berger


Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction  

Microsoft Academic Search

OBJECTIVESThe goal of this study was to determine, in patients with a recent myocardial infarction (MI) and residual wall motion abnormalities within the distribution of the infarct-related artery, whether normal perfusion by myocardial contrast echocardiography (MCE) would accurately predict recovery of segmental left ventricular (LV) function.BACKGROUNDLeft ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Recent

Michael L. Main; Anthony Magalski; Nicholas K. Chee; Michael M. Coen; David G. Skolnick; Thomas H. Good



Complications of Anterior Skull Base Surgery  

PubMed Central

The complications associated with anterior skull base surgery were reviewed in 49 consecutive patients treated between November 1986 and August 1993. All procedures involved a combined otolaryngologic and neurosurgical approach, and the senior otolaryngologist was the same. Fifty-two procedures were completed; 37 for malignant disease and 15 for benign disease. Twenty-one of the 52 procedures had postoperative complications, a 40% complication rate. One postoperative death occurred from a myocardial infarction, for a 2% mortality rate. Infections complications were the most common, occurring in 19% of cases. The one case of meningitis responded to antibiotic therapy, without neurologic sequelae. Seven cerebrospinal fluid leaks occurred (13%); five resolved with conservative management, and two required reoperation. There was no significant difference between complication rates for patients with previous craniotomy, radiation therapy, or chemotherany compared with those with no prior therapy (p > .05). More complications occurred in patients with malignant disease than in those with benign disease (46% vs 27%), but this was not statistically significant (p > .05). Anterior and anterolateral skull base resection as part of a multidisciplinary approach to diseases of this region may provide improved palliation and may offer possible improved survival with acceptable surgical mortality. Although only 6% of patients were left with permanent neurologic sequelse in this series, the risks of serious complications are considerable. ImagesFigure 1p116-bFigure 2Figure 3

Deschler, Daniel G.; Gutin, Philip H.; Mamelak, Adam N.; McDermott, Michael W.; Kaplan, Michael J.



Effects of Nitroglycerin on Myocardial Excursions and Velocities in the Early Hours of Acute Myocardial Infarction  

Microsoft Academic Search

The effects of sublingual nitroglycerin on septal and left ventricular wall motion were determined by echocardiography in the early hours of acute myocar dial infarction (MI) in 20 patients admitted via a mobile coronary care unit. Left ventricular and septal echoes were obtained in 11 patients with acute anterior MI and in 9 with acute inferior MI before and after

Nicholas G. Kounis; George M. Zavras; Paraskevi J. Papadaki; George D. Soufras; Michael P. Kitrou



Management of ST elevation myocardial infarction in pregnancy.  


A 33-year-old lady in the second trimester of pregnancy presented to the emergency department having suffered a cardiac arrest at home. An emergency caesarean section was performed in the resuscitation area. On return of spontaneous circulation, a 12-lead ECG showed anterior ST elevation myocardial infarction. She was transferred to our tertiary centre for an emergency coronary angiography and was successfully treated, making a full recovery. This case report examines the relatively rare entity of myocardial infarction in pregnancy and looks at the mechanisms underlying this. PMID:24114603

Constantine, Andrew Harry; Mozid, Abdul M; Aggarwal, Rajesh



Effects of nerve growth factor on the action potential duration and repolarizing currents in a rabbit model of myocardial infarction  

PubMed Central

Objectives To investigate the effect of nerve growth factor (NGF) on the action potential and potassium currents of non-infarcted myocardium in the myocardial infarcted rabbit model. Methods Rabbits with occlusion of the left anterior descending coronary artery were prepared and allowed to recover for eight weeks (healed myocardial infarction, HMI). During ligation surgery of the left coronary artery, a polyethylene tube was placed near the left stellate ganglion in the subcutis of the neck for the purpose of administering NGF 400 U/d for eight weeks (HMI + NGF group). Cardiomyocytes were isolated from regions of the non-infarcted left ventricular wall and the action potentials and ion currents in these cells were recorded using whole-cell patch clamps. Results Compared with HMI and control cardiomyocytes, significant prolongation of APD50 or APD90 (Action potential duration (APD) measured at 50% and 90% of repolarization) in HMI + NGF cardiomyocytes was found. The results showed that the 4-aminopyridine sensitive transient outward potassium current (Ito), the rapidly activated omponent of delayed rectifier potassium current (IKr), the slowly activated component of delayed rectifier potassium current (IKs), and the L-type calcium current (ICaL) were significantly altered in NGF + HMI cardiomyocytes compared with HMI and control cells. Conclusions Our results suggest that NGF treatment significantly prolongs APD in HMI cardiomyocytes and that a decrease in outward potassium currents and an increase of inward Ca2+ current are likely the underlying mechanism of action.

Lan, Yun-Feng; Zhang, Jian-Cheng; Gao, Jin-Lao; Wang, Xue-Ping; Fang, Zhou; Fu, Yi-Cheng; Chen, Mei-Yan; Lin, Min; Xue, Qiao; Li, Yang



Transesophageal echocardiographic Doppler study of coronary flow in a patient with myocardial bridging--a case report.  


A case report of myocardial bridging of the left anterior descending artery is described. Coronary flow proximal to the myocardial bridge was studied with transesophageal echo Doppler. The patient, a 62-year-old farmer who sustained an anterior myocardial infarction, underwent thrombolysis and was admitted. He subsequently underwent coronary angiography and left ventriculography, which showed a severe myocardial bridge of the midshaft of the left anterior descending artery. The ejection fraction improved from 25 to 48% after thrombolysis, as measured by using echocardiography. Transesophageal Doppler study proximal to the myocardial bridge revealed a relative increase of the diastolic coronary flow velocity (increased acceleration), which reached its peak value in early diastole. Despite the presence of severe myocardial bridging, coronary flow reserve increased substantially two minutes after the infusion of dipyridamole (0.56 mg/kg iv for 4 minutes). Transesophageal Doppler study of coronary blood flow proximal to the myocardial bridge in the left anterior descending artery showed a characteristic waveform that may prove to be indicative of this condition. PMID:9373055

Kranidis, A J; Salachas, A J; Antonellis, I P; Kappos, K G; Patsilinakos, S P; Zamanis, N J; Margaris, N G; Tavernarakis, A G; Anthopoulos, L P



Pathological Views of Injured Myofibers After Myocardial Infarction in a 3D Reconstruction Obtained from Multiple Tissue Sections  

PubMed Central

Adverse left ventricular (LV) remodeling after acute myocardial infarction, characterized by LV dilatation and fibrosis, is a critical factor for prognosis in the subsequent development of heart failure. Though myofiber organization is a key component of cardiac structure, pathological views of injured myofibers during LV remodeling have not been characterized well. In our previous study using ischemia-reperfusion (I/R) injury models in mice, histological assays demonstrated the formation of a broad fibrotic scar extending from the initial infarct zone to a remote zone along mid-circumferential myofibers. However, the fibrosis was contained and did not extend into longitudinal myofibers within the internal and external aspects of the myocardium. We hypothesized that myocyte injury after I/R extends along myofibers but not coronary vessels. However, a histological analysis of tissue sections does not adequately indicate myofiber injury distribution throughout the entire heart. To address this, we investigated patterns of scar formation along myofibers using 3D images obtained from multiple tissue sections of the heart following I/R. Mice were subjected to surgical I/R (30 min-ischemia followed by reperfusion) injury by ligation of the left anterior descending coronary artery (LAD) and examined at 1 week after I/R. Each heart was fixed with 4% polyformaldehyde and cut serially into sections 5-µm thick from base to apex. In total, more than 100 sections were stained with Masson's trichome to identify regions of tissue fibrosis. Of those, 31 representative tissue sections were selected in equal distribution along the base to the apex. To generate the 3D model, digital images of the sections were outlined to highlight fibrotic areas, realigned for anatomic accuracy, and reconstructed using WinSurf v 1.0. The 3D model clearly delineates scar formation along myofibers beginning at the anterior wall of the base and extending inferiorly to the posterior wall of the apex. The pattern was consistent with distribution of the mid-circumferential myofibers. The data suggest that myocyte injury after temporal coronary ligation extends along myofibers rather than coronary vessels. Interestingly, recent clinical reports of patients with post-myocardial infarction evaluated with gadolinium-contrast MRI showed late enhancement of scar tissue limited only to the mid-myocardium in some cases. The same technique could be used to confirm the pattern of scar formation using autopsy samples. Computerized 3D images of histological assays are useful tools for visual analysis of myocardial architecture in I/R models and in the evolution of fibrosis in clinical settings.

Aoyagi, Hiroko; Aoyagi, Toshinori; Lozanoff, Scott; Matsui, Takashi



Myocardial viability assessment in patients with highly impaired left ventricular function: comparison of delayed enhancement, dobutamine stress MRI, end-diastolic wall thickness, and TI 201 SPECT with functional recovery after revascularization  

Microsoft Academic Search

This study compared different magnetic resonance imaging (MRI) methods with Tl201 single photon emission computerized tomography (SPECT) and the “gold standard” for viability assessment, functional recovery after coronary artery bypass grafting (CABG). Twenty patients (64±7.3 years) with severely impaired left ventricular function (ejection fraction [EF] 28.6±8.7%) underwent MRI and SPECT before and 6 months after CABG. Wall-motion abnormalities were assessed

M. Gutberlet; M. Fröhlich; S. Mehl; H. Amthauer; H. Hausmann; R. Meyer; H. Siniawski; J. Ruf; M. Plotkin; T. Denecke; B. Schnackenburg; R. Hetzer; R. Felix



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

SciTech Connect

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.

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



Computed tomographic staging of anterior mediastinal neoplasms.  

PubMed Central

Sixty patients with anterior mediastinal neoplasms undergoing computed tomography before surgical exploration were entered in a prospective study to assess the value of computed tomography in the preoperative staging of anterior mediastinal tumours. Correct prediction of location, size, and tissue density was obtained in all 60 cases. Correct identification of the nature of the tumours was achieved by computed tomography in 37 of the 54 previously undiagnosed cases. Particular attention was given to the evaluation of the relation of the tumour to adjacent mediastinal structures, to predict the feasibility of radical surgical procedures. Overall sensitivity, specificity, and accuracy in identifying resectability were 46%, 85%, and 64%, with positive and negative predictive indices of 78% and 58%. Capsulated or highly invasive lesions were clearly distinguished, and the presence or absence of infiltration of mediastinal vessels, pericardium, and chest wall was correctly recognised in most cases. It is suggested that the evaluation of anterior mediastinal neoplasms should include computed tomography because of its accuracy in predicting size, location, and tissue density of the neoplasm. Computed tomography may suggest, often with good reliability, the histological type of the tumour and its relation to contiguous mediastinal structures, thus contributing to the choice of the appropriate surgical approach or route for biopsy. Images

Rendina, E A; Venuta, F; Ceroni, L; Martelli, M; Gualdi, G; Caterino, M; Ricci, C



Myocardial ischemia during sleep.  


The role of sleep in the pathogenesis of coronary ischaemic events such as myocardial infarction, transient myocardial ischaemia, or cardiac sudden death, is unclear. This review will analyse the available data on the subject according to: (i) the autonomic and cardiovascular changes during sleep that may potentially favour myocardial ischaemia; (ii) the evidence of a circadian distribution of coronary events; and (iii) the factors possibly involved in the pathogenesis of nocturnal angina. Available data suggest that myocardial ischaemia may occur by different mechanisms in non-rapid eye movement (NREM) (decreased coronary perfusion pressure) and rapid eye movement (REM) sleep (increased myocardial oxygen demand). Coronary events show a major peak of occurrence between 6.00 a.m. and noon; however, the myocardial ischaemic threshold, defined as the heart rate value at which myocardial ischaemia develops, may be lower at night than during the daytime, suggesting an unexpectedly higher susceptibility to myocardial ischaemia during sleep than during wakefulness. These data warrant further study on the pathophysiology of coronary circulation during sleep. Finally, some evidence is available that sleep disordered breathing may precipitate nocturnal angina especially in REM sleep, through decreased arterial oxygen content secondary to hypoventilation or true apnoeas. More data are needed to better understand the effects of sleep on the coronary circulation, and to improve the therapeutic approach of nocturnal angina. PMID:15310478

Bonsignore, M R; Smirne, S; Marrone, O; Insalaco, G; Salvaggio, A; Bonsignore, G




Microsoft Academic Search

Summary. The application of temporary electro-stimulation is necessary in acute myocardial infarction complicated by the appearance of symptomatic bradycardia, AV conduction disturbances and asystolia. During the last two years, 38 of 892 patients (4.2%) with the diagnosis of acute myocardial infraction with ST segment elevation, required temporary electro-stimulation (27 with inferior infractions and 11 with anterior infraction). The third degree

Mirko Burazor


Anomalous origin of the left coronary artery: angiographic and myocardial perfusion scintigraphic correlates  

SciTech Connect

We studied a patient with an anomalous left coronary artery arising from the pulmonary artery by using conventional angiographic and myocardial imaging techniques. Myocardial imaging with radioactive 201thallium confirmed the significance of resting Q waves, and the defect in anterior perfusion coupled with the presence of thallium in the pulmonary outflow tract during exercise underscored the dynamic nature of the ischemic response to exercise in this syndrome.

Young, M.W.; Hamby, R.I.; Zaret, B.



Cardiovascular magnetic resonance of acute myocardial infarction following traumatic coronary artery dissection.  


Traumatic coronary artery dissection is a very rare cause of myocardial infarction. Occurrence of this condition late in the posttraumatic period is extremely uncommon. We present a case of a young patient with acute myocardial infarction 4 weeks after blunt chest trauma. Coronary angiography showed left anterior descending artery dissection as well as thrombus formation, and multiple small infarctions were shown by cardiovascular magnetic resonance. PMID:20686414

Mahmod, Masliza; Wage, Rick; Alpendurada, Francisco; Pennell, Dudley J



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


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.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2784620

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



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

SciTech Connect

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.

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



A rare noncardiac cause for acute myocardial infarction in a 13-year-old patient.  


A case of ST-segment elevation myocardial infarction in an adolescent patient is presented. The patient presented with resting angina and echocardiographic evidence of wall motion abnormalities in the inferior and posterior segments. The patient was known to have metastatic hepatocellular carcinoma. Tumor was seen in the left inferior pulmonary vein and is proposed to be the source of embolism-causing myocardial infarction. Secondary to intracranial metastatic lesions, the patient was treated conservatively with opiates, nitrates, and beta-blockers. This case is an opportunity to review the causes and management of myocardial infraction in pediatric patients and represents a rare cause of embolic myocardial infraction. PMID:14667262

Aragon, Joseph


Role of leukocytes and platelets in acute myocardial infarction  

SciTech Connect

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.

Bednar, M.M.



[Relationship between the ECG and MRI findings in acute myocardial infarction].  


Objective: To evaluate the agreement between de ECG leads with ST elevation and the myocardial segments that present myocardial edema in the MRI study, in patients with acute myocardial infarction. Methods: There were included 91 patients with a first ST elevation myocardial infarction (STEMI) with reperfusion therapy during the first 12 hours of onset symptoms, in whom a Cardiovascular Magnetic Resonance (CMR) was done (mean 3 day after the ischemic event). Among the ECG leads (thoracic circle), there were identified those with ST higher elevation. In the CMR there were evaluated the myocardial segments with edema (T2-weighted sequence with hyperintensity). Results: The ECG leads with the best sensibility in the detection of injury, corresponding to cellular edema, were: basal anterior and anteroseptal: V2; basal inferoseptal LIII and aVF; basal inferior and inferolateral: LIII; basal anterolateral V7-V9; mid anterior and anteroseptal:V2 and V3; mid inferoseptal, inferior and inferolateral: LIII and aVF; mid anterolateral V2 and V8; apical anterior and septal: V2-V4; apical inferior and lateral: LII, LIII and aVF; apex: V2-V4. Conclusions: The surface ECG leads with higher ST elevation corresponded to the myocardial segments with more important edema (defined as someone with hyperintensity in the T2- weighted MRI sequence). PMID:22188884

Meléndez-Ramírez, Gabriela; de Micheli, Alfredo; Fratti, Víctor; Meave-González, Aloha; González-Pacheco, Héctor; Alexánderson, Erick


No gender difference in the extent of myocardial ischemia in non-ST elevation myocardial infarction.  


Background: Significant gender differences in angiographic severity of coronary artery disease (CAD) have been demonstrated among patients with non-ST-elevation myocardial infarction (NSTEMI). However, it is unknown if these gender differences are reflected in the extent of myocardial ischemia.Design and methods: We assessed segmental myocardial wall motion and perfusion by contrast echocardiography in 110 patients (34 women and 76 men) with NSTEMI prior to scheduled coronary angiography. The extent of myocardial ischemia using a 17-segment left ventricular (LV) model was compared to quantitative coronary angiography (QCA).Results: Age (70 ± 12 vs 66 ± 12 years), troponin T level (0.53 ± 0.66 vs 0.75 ± 1.32 µg/l), Thrombolysis In Myocardial Infarction (TIMI) risk score (3.2 ± 1.4 vs 3.5 ± 1.4), LV ejection fraction and cardiovascular risk factor burden did not differ between genders. As expected, women had less severe findings on coronary angiography but the extent of myocardial ischemia by contrast echocardiography was comparable in women and men. In multivariable analysis, the risk of having prognostically severe angiographic CAD increased by 29% in women and by 49% in men for every additional LV segment with ischemia, independent of TIMI risk score (both p < 0.01).Conclusion: The present contrast echocardiography study in NSTEMI patients demonstrates that women with NSTEMI have the same extent of LV myocardial ischemia as men in spite of less prevalent angiographic CAD. The findings may help explain why less severe angiographic findings in women with NSTEMI are not accompanied by lower mortality. PMID:22752464

Lønnebakken, Mai T; Nordrehaug, Jan E; Gerdts, Eva



Clinical Observation of Myocardial Bridge  

Microsoft Academic Search

Background:A myocardial bridge (MB is an anatomical arrangement in which a limited segment of an epi- cardial coronary artery becomes engulfed by myocardial fibers. Although it has generally been felt that most instances of bridginge are benign, recent reports have suggested that MB can be associated with evidence of myocardial ischemia, myocardial infarction, arrhythmia and sudden death. This study investigated

Seung Mook Jeung; Tae Kyeong Won; Rak Kyeong Choi; Jae Kim; Nae Hee Lee; Dal Soo Lim; Hweung Kon Hwang


Improved angina threshold and coronary reserve following direct myocardial revascularization.  


Angina threshold, coronary reserve, and global myocardial lactate metabolism were studied by atrial pacing in 18 patients with obstructive coronary artery disease before and after aortocoronary artery bypass (ACB) surgery. In 3 of these 18 patients, regional (anterior wall) metabolism was also studied. Following ACB, 16 of the 18 patients did not develop angina at the maximum pacing rate (MPR). One patient developed angina postoperatively at a similar rate as before surgery. In the other patient, postoperative angina threshold was much higher. In the group as a whole, postoperative MPR (159 +/- 3.5 beats/min) was much higher than the preoperative angina rate (124.9 +/- 4.9 beats/min; P less than 0.001). Rate-pressure product (RP) at MPR postoperatively (21.5 +/- 0.89 mm Hg/min X 10(-3)) was also higher than RP at angina rate preoperatively (18.8 +/- 0.92 mm Hg/min X 10(-3); P less than 0.01). Although coronary sinus blood flow (CSBF) both at rest (152 +/- 16.2 ml/min) and at MRP (266 +/- 27.5 ml/min) postoperatively was higher than preoperative CSBF at rest (111 +/- 10.7 ml/min; P less than 0.05) and at angina rate (202 +/- 19.9 ml/min; P less than 0.05), arterial-coronary sinus O2 content (Art.-CSO2) difference was significantly lower postoperatively both at rest (8.9 +/- 0.37 ml/min) and at MPR (9.1 +/- 0.44 ml/min) compared with the preoperative Art.-CSO2 at the rest (12.7 +/- 0.40 ml/min; P less than 0.01) and at angina rate (12.4 +/- 3.8 ml/min; P less than 0.01)... PMID:1080446

Chatterjee, K; Matloff, J M; Swan, H J; Ganz, W; Sustaita, H; Magnusson, P; Buchbinder, N; Henis, M; Forrester, J S



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

SciTech Connect

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.

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



Imaging of the seronegative anterior chest wall (ACW) syndromes  

Microsoft Academic Search

The sternocostoclavicular (SCC) region is subject to the same diseases that occur in joints, with congenital and developmental\\u000a anomalies, inflammatory and infectious diseases, soft tissue and bone tumors as well as the seronegative spondyloarthropathies,\\u000a including ankylosing spondylitis, reactive arthritis, enteropathic arthritis, psoriatic arthritis, pustulosis palmoplantaris\\u000a and other syndromes. Most of these conditions present with swelling of the joint, which may

Giuseppe Guglielmi; Giacomo Scalzo; Alessia Cascavilla; Fausto Salaffi; Walter Grassi



Prognostic value of echocardiography after acute myocardial infarction  

Microsoft Academic Search

Echocardiography is useful for risk stratification and assessment of prognosis after myocardial infarction, which is the focus of this review. Various traditional echocardiographic parameters have been shown to provide prognostic information, such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and left atrial volume. The introduction of tissue Doppler imaging and speckle-tracking strain imaging has

S A Mollema; G Nucifora; J J Bax



Giant Cell Tumor Arising from Anterior Arc of the Rib  

PubMed Central

A primary giant cell tumor of the rib is very rare. The most common site of a giant cell tumor arising from the rib is the posterior arc. A giant cell tumor arising from the anterior arc of the rib is extremely rare. The treatment of a giant cell tumor of the rib is not well defined. Generally, a complete surgical resection is performed in a patient with a primary giant cell tumor of the rib. We report a case of a giant cell tumor arising from the anterior arc of the rib that was treated with a wide excision and chest wall reconstruction.

Heo, Woon; Min, Ho-Ki; Jun, Hee Jae; Hwang, Youn-Ho



Improvement of Prostate Treatment by Anterior Proton Fields  

SciTech Connect

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.

Tang, Shikui [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Both, Stefan [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Bentefour, Hassan [Ion Beam Applications (IBA), Louvain la Neuve (Belgium); Paly, Jonathan J. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Tochner, Zelig [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Efstathiou, Jason [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Lu, Hsiao-Ming, E-mail: [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)



QRS complex recovery during one year after acute myocardial infarction.  


The recovery of the ECG signs of anterior myocardial infarction has been studied in 70 patients. A significant increase in R-wave amplitude and decrease in Q-wave amplitude on 24-lead precordial mapping was observed during one year after infarction. Patients with lower initial heart rate showed a greater recovery of R- and Q-wave amplitudes, as did patients with smaller infarcts, as assessed by peak heat-stable lactate dehydrogenase (LDH). PMID:3545575

Richter, A; Herlitz, J; Hjalmarson, A



A minimally-invasive closed chest myocardial occlusion-reperfusion model in rhesus monkeys ( Macaca mulatta ): monitoring by contrast-enhanced ultrasound imaging  

Microsoft Academic Search

Myocardial infarction is frequently developed in canine and porcine models but exceptionally in non-human primates. The aim\\u000a of this study was to develop a minimally invasive myocardial ischemic\\/reperfusion model in the monkey intended to be combined\\u000a with imaging techniques, in particular myocardial contrast echocardiography (MCE). A balloon-tipped catheter was advanced\\u000a via the femoral artery into the left anterior descending artery

Hugues Contamin; Gilles Rioufol; Thierry Bettinger; Alexandre Helbert; Karine G. Portier; Olivier M. Lepage; Regi Thomas; Anne Broillet; François Tranquart; Michel Schneider


Primary ST changes. Diagnostic aid in paced patients with acute myocardial infarction.  

PubMed Central

In 34 out of 36 patients with apical right ventricular endocardial pacing, primary ischaemic ST alterations were observed during the early stage of acute myocardial infarction. These ST changes, indicating acute injury, were detected in the paced beats in inferior and in anterior infarct. The primary ST changes were consistent only during the early stages of acute myocardial infarction and were not detected when the electrode tip was not in the apex of the right ventricle. It is suggested that the primary ST changes should be used to diagnose acute myocardial infarction in paced patients. Images

Niremberg, V; Amikam, S; Roguin, N; Pelled, B; Riss, E



Scheimpflug imaging in anterior megalophthalmos  

PubMed Central

We report an anterior megalophthalmos case with decreased corneal thickness and show the findings using Scheimpflug imaging. A 25-year-old male was diagnosed with anterior megalophthalmos. In both eyes, enlarged corneal length was measured. Beside a comparatively good visual acuity, a thin but clear cornea, a fairly deep anterior chamber, and central lens opacity were found. Scheimpflug images were taken using Pentacam HR. Scheimpflug-based imaging can provide us new data at the examination of this syndrome affecting the whole anterior segment.

Nemeth, Gabor; Hassan, Ziad; Berta, Andras; Modis, Laszlo



Combination of Enoxaparin and Fibroblast Growth Factor1 Increases Myocardial Blood Flow and Capillary Density after Myocardial Infarction in Rabbits  

Microsoft Academic Search

Objective: The effect of enoxaparin and fibroblast growth factor-1 (FGF-1) on post-infarction capillary density and regional myocardial blood flow (RMBF) was examined. Methods: New Zealand White rabbits received an intramyocardial injection of either physiological saline, FGF-1 + enoxaparin, FGF-1 or enoxaparin directly after ligation of the left anterior descending artery. RMBF and capillary density were investigated using fluorescent microspheres and

Andrea Geist; Jana Marx; Silke Müller; A. Uzan; B.-U. von Specht; J. Haberstroh



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

SciTech Connect

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.

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



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

NASA Astrophysics Data System (ADS)

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 ?m) 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.

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



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

SciTech Connect

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.

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.



Importance of the time of onset of supraventricular tachyarrhythmias on prognosis of patients with acute myocardial infarction.  


It is known that left ventricular (LV) function, severity of coronary artery disease, and the presence of ventricular arrhythmias are major determinants of prognosis in patients surviving an acute myocardial infarction (AMI). However, little is known about the relationship between the time of onset of supraventricular tachyarrhythmias (SVTs) and mortality. Therefore, this study was carried out in a 48-months period on 131 patients with AMI who presented with SVT during hospitalization. Of these, 53 patients (40.5%) had arrhythmia within < 12 h of MI, while 78 patients (59.5%) had arrhythmia between 12 h and 4 days. The arrhythmias studied were atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia. The patients were similar for age, gender, coronary risk factors, creatine kinase-MB peak, cardioversion and LV function. Angiographic features for patients with the < 12-h onset of arrhythmia were: 86.7% of the patients had uniarterial lesions, 8.9% had biarterial lesions, and 4.4% had triarterial lesions. Patients with the 12-h-4-day onset had 16.1%, 53.2%, and 30.6% (p < or = 0.05) of the respective lesions. Inferior wall myocardial infarction was more frequent among patients with the earlier onset (60.4%), while patients with the later onset presented more anterior wall infarctions (50.0%). Only 11.3% of the patients with the earlier onset presented with severe in-hospital congestive heart failure (Killip classes III-IV), versus 62.8% of the patients with the later onset (p < or = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7720295

Serrano, C V; Ramires, J A; Mansur, A P; Pileggi, F



Wall Turbulence.  

ERIC Educational Resources Information Center

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)

Hanratty, Thomas J.



Wall Tension  

NSDL National Science Digital Library

This page of Hyperphysics, from Georgia State University, develops the relationship between tension, pressure, and radius in a balloon. The same ideas are then applied to the walls of spherical and cylindrical containers. Several links provide further information.

Nave, Carl R.



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

NASA Astrophysics Data System (ADS)

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.

McCollough, Cynthia H.


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

SciTech Connect

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.

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. (Univ. of Texas Southwestern Medical Center, Dallas (USA))



Endothelial Cysteinyl Leukotriene 2 Receptor Expression Mediates Myocardial Ischemia-Reperfusion Injury  

PubMed Central

Cysteinyl leukotrienes (CysLTs) have been implicated as inflammatory mediators of cardiovascular disease. Three distinct CysLT receptor subtypes transduce the actions of CysLTs but the role of the endothelial CysLT2 receptor (CysLT2R) in cardiac function is unknown. Here, we investigated the role of CysLT2R in myocardial ischemia-reperfusion (I/R) injury using transgenic (tg) mice overexpressing human CysLT2R in vascular endothelium and nontransgenic (ntg) littermates. Infarction size in tg mice increased 114% compared with ntg mice 48 hours after I/R; this increase was blocked by the CysLT receptor antagonist BAY-u9773. Injection of 125I-albumin into the systemic circulation revealed significantly enhanced extravasation of the label in tg mice, indicating increased leakage of the coronary endothelium, combined with increased incidence of hemorrhage and cardiomyocyte apoptosis. Expression of proinflammatory genes such as Egr-1, VCAM-1, and ICAM was significantly increased in tg mice relative to ntg controls. Echocardiographic assessment 2 weeks after I/R revealed decreased anterior wall thickness in tg mice. Furthermore, the postreperfusion time constant ? of isovolumic relaxation was significantly increased in tg animals, indicating diastolic dysfunction. These results reveal that endothelium-targeted overexpression of CysLT2R aggravates myocardial I/R injury by increasing endothelial permeability and exacerbating inflammatory gene expression, leading to accelerated left ventricular remodeling, induction of peri-infarct zone cellular apoptosis, and impaired cardiac performance.

Jiang, Wei; Hall, Sean R.; Moos, Michael P.W.; Cao, Richard Yang; Ishii, Satoshi; Ogunyankin, Kofo O.; Melo, Luis G.; Funk, Colin D.



Myocardial Infarction Research Unit.  

National Technical Information Service (NTIS)

Five hundred patients have undergone hemodynamic evaluation in the Myocardial Infarction Research Unit. Over 200 of these studies have been carried out within the first 24 hours of infarction. The relation of hemodynamic parameters to patient survival has...

B. Pitt



Silent myocardial ischemia.  


Encouraging gains have been made during the last decade toward the identification of silent myocardial ischemia as a clinical form of coronary heart disease and also as its earliest and most common manifestation. Many efforts have also been made in elucidating the incidence, pathogenesis, pathophysiology, as well as the specificity of laboratory tests and the relation to risk factors and to symptomatic ischemic episodes. Once thought to be an unusual phenomenon, largely confined to anecdotal reports, silent myocardial ischemia is now recognized to be a common occurrence in the middle-aged and elderly people. The first part of this selective review summarizes major findings and conclusions concerning: (a) the identification of silent myocardial ischemia as the earliest form of coronary heart disease; (b) the selection of patients; (c) the particular feature of silent myocardial ischemia pathogenesis. PMID:2683007

Velican, C; Sipciu, D


Anterior uveitis associated with latanoprost  

Microsoft Academic Search

Purpose: To report the association of anterior uveitis with the use of latanoprost.Methods: We studied four patients with complicated open-angle glaucoma who had anterior uveitis associated with the use of latanoprost. The uveitis was unilateral and occurred only in the eye receiving latanoprost in three patients. In one patient, latanoprost was used in both eyes, and the uveitis was bilateral.

Robert D. Fechtner; Albert S. Khouri; Thom J. Zimmerman; John Bullock; Robert Feldman; Prasad Kulkarni; Andrew J. Michael; Tony Realini; Ronald Warwar



Effect of Mechanically Simulated Diaphragmatic Respiratory Motion on Myocardial SPECT Processed With and Without Attenuation Correction  

Microsoft Academic Search

The goal of this study was to assess the effect of diaphragmatic respiratory motion on inferior wall cold artifact in myocardial SPECT and to assess the ability of attenuation correction (AC) to correct for this artifact in the presence of diaphragmatic motion. Methods: We used an anthropomorphic phantom with ventricular wall activity, variable ventricular caudal tilt, attenuat- ing liver and

Alexander G. Pitman; Victor Kalff; Borghild Risa; Leighton R. Barnden; Michael J. Kelly


Layer-specific strain analysis: investigation of regional deformations in a rat model of acute versus chronic myocardial infarction.  


Myocardial infarction (MI) injury extends from the endocardium toward the epicardium. This phenomenon should be taken into consideration in the detection of MI. To study the extent of damage at different stages of MI, we hypothesized that measurement of layer-specific strain will allow better delineation of the MI extent than total wall thickness strain at acute stages but not at chronic stages, when fibrosis and remodeling have already occurred. After baseline echocardiography scans had been obtained, 24 rats underwent occlusion of the left anterior descending coronary artery for 30 min followed by reperfusion. Thirteen rats were rescanned at 24 h post-MI and eleven rats at 2 wk post-MI. Next, rats were euthanized, and histological analysis for MI size was performed. Echocardiographic scans were postprocessed by a layer-specific speckle tracking program to measure the peak circumferential strain (S(C)(peak)) at the endocardium, midlayer, and epicardium as well as total wall thickness S(C)(peak). Linear regression for MI size versus S(C)(peak) showed that the slope was steeper for the endocardium compared with the other layers (P < 0.001), meaning that the endocardium was more sensitive to MI size than the other layers. Moreover, receiver operating characteristics analysis yielded better sensitivity and specificity in the detection of MI using endocardial S(C)(peak) instead of total wall thickness S(C)(peak) at 24 h post-MI (P < 0.05) but not 2 wk later. In conclusion, at acute stages of MI, before collagen deposition, scar tissue formation, and remodeling have occurred, damage may be nontransmural, and thus the use of endocardial S(C)(peak) is advantageous over total wall thickness S(C)(peak). PMID:22777422

Bachner-Hinenzon, Noa; Ertracht, Offir; Malka, Assaf; Leitman, Marina; Vered, Zvi; Binah, Ofer; Adam, Dan



Assessment of myocardial perfusion in patients after the arterial switch operation  

SciTech Connect

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.

Vogel, M.; Smallhorn, J.F.; Gilday, D.; Benson, L.N.; Ash, J.; Williams, W.G.; Freedom, R.M. (Univ. of Toronto Faculty of Medicine, Ontario (Canada))



[Angiotensin converting enzyme inhibitors in acute period of myocardial infarction: the place of zofenopril].  


Acute myocardial infarction (MI) is one of main predecessors of chronic heart failure (CHF), for the treatment of which angiotensin converting enzyme inhibitors (ACEI) are recommended at present. It seems logical to prescribe ACEI in early period of MI in order to prevent development of CHF in postinfarction period. For assessment of benefit and risk related to prescription of ACEI early after onset of acute MI multiple placebo controlled trials have been carried out. Data obtained in these trials evidence for inexpediency of wide use of ACEI in acute period of MI. Several categories of patients with acute MI with stable hemodynamics have been established in whom benefit of early prescription of ACEI noticeably outweighs possible risk. Those are patients with clinical manifestations of CHF or echocardiographical signs of systolic left ventricular dysfunction as well as patients with high risk of development of CHF in postinfarction period. The latter group comprises patients with transmural MI of the anterior left ventricular wall in whom thrombolytic therapy either have not been carried out or have been ineffective, patients with diabetes mellitus or hypertension in anamnesis. In all other cases prescription of ACEI in early period of acute MI might be dangerous because hypotension induced by them can worsen blood flow and aggravate ischemic injury of the myocardium and increase dimensions of MI. PMID:16858365

Preobrazhenski?, D V; Sidorenko, B A; Pershukov, I V; Batyraliev, T A; Pataraia, S A



Targeted Delivery of VEGF after a Myocardial Infarction Reduces Collagen Deposition and Improves Cardiac Function  

PubMed Central

The development of adjunctive therapies which attenuate adverse remodeling and improve LV function post myocardial infarction (MI) is of significant clinical interest. Previously, we have shown that targeted delivery of therapeutic vascular endothelial growth factor (VEGF) to the infarct border zone significantly increases vascular perfusion and results in improvements in LV function. In this study, we tested the hypothesis that improvements in cardiac function observed with this novel targeted drug delivery system strongly correlate with reductions in collagen deposition in the scar tissue after an MI. Rats received anti-P-selectin conjugated immunoliposomes containing VEGF immediately post-MI. Over 4 weeks, evolutionary changes in LV geometry and function were correlated with collagen deposition and infarct size quantified by Gomori's trichrome and picrosirius red staining. Targeted VEGF treated hearts showed a 37% decrease in collagen deposition in the anterior wall, as well as significant improvements in LV filling pressures. Multi-regression analysis showed that the extent of collagen deposition post MI can be predicted by a linear combination of normalized LV mass and ejection fraction. Targeted delivery of VEGF post-MI results in significant decreases in collagen deposition and adverse remodeling. Improvements in cardiac function in this model are related to degree of collagen deposition and extent of scar formation.

Rosano, Jenna M.; Cheheltani, Rabee; Wang, Bin; Vora, Hardik; Kiani, Mohammad F.; Crabbe, Deborah L.



[Acute myocardial infarction with normal coronary angiography: a 46-cases descriptive study].  


This a retrospective study on 46 patients conducted over a 9-year period. These patients had an acute myocardial infarctus (AMI) confirmed wilth changes on the electrocardiogram and raised cardiac enzymes. However, the subsequent coronary angiography showed normal in all these patients. The purpose of our study is to assess epidemiologic, clinical, pronostic and therapeutic features of AMI with angiographically normal coronary arteries and compare the results obtained with those of AMI with coronary artery disease. AMI with angiographically normal coronary arteries is a first coronary event in young patients (mean age 47.7 years) having few coronary risk factors (54.3% have only one risk factor) mainly smoking (73.9%). The anterior location is prevalent. The patients with AMI and angiographically normal coronary arteries have a better prognosis than those with coronary artery stenosis. Indeed, their left ventricular function is unaltered (mean ejection fraction 48.7%). Hypokinesis is the most frequent abnormality of wall motion noticed. The patients' post infarction course is bengin when the coronary arteries are angiographically normal. The incidence of hemodynamic complications and ischemic recurrences are lower than in AMI with coronary stenosis. The choice treatment remains fibrinolysis. PMID:15969232

Ben Ameur, Youssef; Dekhil, Ibtissem; Baraket, Fériel; Terras, Mouna; Longo, Selma; Kraiem, Sondos; Slimane, Mohamed Lotfi



Left ventricular strain, rotation, and torsion as markers of acute myocardial ischemia.  


This study investigates how tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) describe regional myocardial deformation during controlled reductions of left anterior descending (LAD) coronary artery perfusion pressure. In eight anesthetized pigs, a shunt with constrictor was installed from the brachiocephalic artery to the LAD. Data were obtained with open shunt, followed by four degrees of stenosis (S1-S4) of increasing severity: S1, ?15%; S2, ?35%; S3, ?50%; and S4, ?60% reductions of LAD perfusion pressure. At each situation, microspheres for perfusion measurements were injected and left ventricular (LV) short- and long-axis cineloops were recorded. In the anterior wall, radial, circumferential, and longitudinal one-layer STE strain, one-layer radial TDI strain, and three-layer radial TDI and STE strain were measured. LV peak mean rotation was measured at six equidistant levels from apex to base (in 7 pigs). LV torsion was calculated from end-systolic mean rotation. With open shunt, three-layer TDI analysis showed a transmural strain gradient with no perfusion gradient. Perfusion, one-layer TDI strain, and strain in the mid- and subendocardium from three-layer TDI were reduced at S2 (P < 0.05). STE strain was not affected until S3 (P < 0.05). Peak mean rotation, increasing toward the apex, decreased at the three apical levels at S4 (P < 0.05). LV torsion did not decrease (P = 0.26). In conclusion, TDI strain detected dysfunction already with minor changes in global hemodynamics, whereas STE strain was first reduced with moderate changes. LV peak mean rotation was not reduced until severe reduction of LAD perfusion pressure, but remained increasingly counterclockwise toward the apex. LV torsion remained unaffected by ischemia. PMID:21441314

Moen, Christian Arvei; Salminen, Pirjo-Riitta; Grong, Ketil; Matre, Knut



Septal Perfusion and Wall Thickening in Patients with Left Bundle Branch Block Assessed by Technetium99m-Sestamibi Gated Tomography  

Microsoft Academic Search

Septal hypoperfusion is often observed in patients with complete left bundle branch block (LBBB) in myocardial perfusion imaging. Abnormal wall motion in the septal region may potentially cause artifactual perfusion abnormalities. To assess the effect of abnormal wall thickening on myocardial perfusion images, ECG-gated sesta- mibi SPECT was performed on 12 patients with LBBB and 10 normal subjects used as

Hideki Sugihara; Nagara Tamaki; Masato Nozawa; Tomoko Ohmura; Yasuhiko Inamoto; Yoshimitsu Taniguchi; Etsuo Aoki; Kenichi Mitsunami; Masahiko Kinoshita


[ACE inhibitors after myocardial infarction: close-up on zofenopril].  


The angiotensin-converting enzyme (ACE) inhibitors have a necessary place in the follow-up of myocardial infarction. Their benefits have been extended little by little. When clinical trials conducted with zofenopril began with a vast study program called SMILE, certain questions remained unanswered, notably the long-term benefit of the ACE inhibitors beyond a short administration period. SMILE (Survival of Myocardial Infarction Long-Term Evaluation), begun in 1995, is studying zofenopril to determine the effects of using this ACE inhibitor in the follow-up of myocardial infarction. During the course of the different study phases, zofenopril has successively demonstrated benefits on the reduction of morbidity and mortality after anterior myocardial infarction in STEMI patients, benefits that are maintained over the long term, since at 1 year, the mortality rate is significantly lower in the zofenopril group compared to the placebo group. SMILE's analyses have shown the value of zofenopril in subpopulations, particularly at-risk patients, hypertensive patients, and diabetics, whose prognosis after infarction is more severe than in populations without hypertension or diabetes. Zofenopril can be administered early, even in a more favorable situation, to myocardial infarction patients with no ST-segment elevation (NSTEMI). The SMILE program is continuing, notably with SMILE IV, where it is being compared to ramipril, and in the ZAAMIS trial, designed to confirm its vasculoprotective effects. PMID:17482555

Teyssedou, A



Relationship between segmental thallium-201 uptake and regional myocardial blood flow in patients with coronary artery disease  

SciTech Connect

The relationship between the spatial distribution of thallium-201 in myocardial perfusion scintigrams and the distribution of left ventricular regional myocardial blood flow was examined in 25 patients undergoing coronary arteriography. Thallium-201 myocardial scintigrams were obtained after symptom-limited exercise and after a 4 hr delay. Regional myocardial blood flow was measured by the xenon-133 clearance method in patients at rest and during rapid atrial pacing to a double product comparable with that achieved during exercise stress testing. Patterns of regional thallium-201 activity and regional myocardial blood flow, recorded in similar left anterior oblique projections, were compared for left ventricular segments supplied by the left anterior descending (LAD) and left circumflex (CIRC) arteries. In 11 patients without significant lesions of the left coronary artery (group 1), thallium-201 was homogeneously distributed in the LAD and CIRC distributions in scintigrams taken during peak exercise; these scintigrams correspond to homogeneous regional myocardial blood flow in the LAD and CIRC regions during pacing-induced stress. In 14 patients with significant lesions of the left coronary artery (group 2), ratios of regional thallium-201 activity in the LAD and CIRC distributions of exercise scintigrams correlated well (r . .84) with ratios of regional myocardial blood flow measured during rapid pacing. Background subtraction altered the relationship between relative thallium-201 uptake and regional myocardial blood flow, causing overestimation of the magnitude of flow reduction on exercise scintigrams.

Nichols, A.B.; Weiss, M.B.; Sciacca, R.R.; Cannon, P.J.; Blood, D.K.



EKG Criteria Predict Infarct-related Artery of Inferior Wall AMI  

Microsoft Academic Search

Background: We attempted to predict the infarct-related artery (IRA) of inferior wall acute myocardial infarction (AMI) by assessing the relative ST-segment deviation on surface electrocardiogram (EKG). Methods and Results: We evaluated 12-lead and right-sided EKG with ST-segment elevation-type inferior wall AMI from 528 consecutive patients with AMI in Chi-Mei Foundation Hospital between 1999 and 2002. Patients with previous myocardial infarction

Chun-Yen Chiang; Po-Ming Ku; Tsuei-Yuan Huang; Chen-Chuan Cheng; Wen-Shiann Wu; Zhih-Cherng Chen; Ming-Ting Chou


Effect of propranolol on enzymatic and histochemical estimates of infarct size in experimental myocardial infarction  

Microsoft Academic Search

Summary Acute myocardial infarction was produced in anesthetized dogs by ligation of the left anterior descendens coronary artery. Propranolol (2 mg\\/kg i.v.) administered 4 hours post ligation was examined for its ability to reduce infarct size estimated by histochemical and enzymatic methods. There was a significant correlation between these two methods in their estimation of infarct size. Treatment with propranolol

G. J. Jesmok; D. C. Warltier; G. J. Gross; H. F. Hardman



Inhalation of Concentrated Ambient Air Particles Exacerbates Myocardial Ischemia in Conscious Dogs  

Microsoft Academic Search

Short-term increases in ambient air pollution have been associated with an increased incidence of acute cardiac events. We assessed the effect of inhalation exposure to concentrated ambient parti- cles (CAPs) on myocardial ischemia in a canine model of coronary artery occlusion. Six mongrel dogs underwent thoracotomy for implantation of a vascular occluder around the left anterior descending coronary artery and

Gregory A. Wellenius; Brent A. Coull; John J. Godleski; Petros Koutrakis; Kazunori Okabe; Sara T. Savage; Joy E. Lawrence; G. G. Krishna Murthy; Richard L. Verrier



Spontaneous Isolated Coronary Artery Dissection With Myocardial Infarction Treated With Heart Transplantation  

Microsoft Academic Search

A case of spontaneous isolated dissecting aneurysm of the left main and anterior descending branches of the left coronary artery in a 42-year-old woman is described. The patient survived the dissection, and resultant myocardial infarct with cardiogenic shock was treated with an orthotopic cardiac transplant. She died from a bilateral pneumonia caused by Candida tropicalis 3 weeks later. Spontaneous isolated

J. Fernando Val-Bernal; Concepción Alvarez-Cañas; José L. Vega; Juan J. Olalla



Subarachnoid Hemorrhage Misdiagnosed as an Acute ST Elevation Myocardial Infarction  

PubMed Central

Without significant coronary artery stenosis, ischemic electrocardiographic change including ST segment elevation, segmental wall motion abnormality and elevated serum cardiac-specific markers (creatine kinase-MB, Troponin-T) may develop after central nervous system injuries such as subarachnoid, intracranial or subdural hemorrhage. Misdiagnosing these patients as acute myocardial infarction may result in catastrophic outcomes. By reporting a case of a 55-year old female with subarachnoid hemorrhage mimicking acute ST elevation myocardial infarction, we hope to underline that careful attention of neurologic abnormality is critical in making better prognosis.

Heo, Woon Je; Jeong, Woo Shin; Jeong, Mi Yeon; Lee, Sang Hyuk; Seo, Jeong Yeun; Jo, Sang Won



Echocardiography in the Assessment of Complications of Myocardial Infarction  

PubMed Central

The value of echocardiography as a tool for evaluating the prognosis of patients after myocardial infarction lies in its ability to define the region and extent of ischemic damage. Additionally, echocardiography is useful in assessing and predicting postinfarction complications. Wall motion abnormalities, pericardial effusion, left ventricular thrombi, and left ventricular aneurysms and pseudoaneurysms can be detected using echocardiography. The severity of mitral regurgitation and the location of interventricular septal repture can also be assessed using echocardiography. This diagnostic tool can provide vital information regarding the appropriate clinical management of patients after myocardial infarction. (Texas Heart Institute Journal 1991; 18:237-42) Images

Wilansky, Susan



Hadrian's Wall  

NSDL National Science Digital Library

Hadrian's Wall is an historical monument built by the Romans in Britain and spans more than 2,000 years of history. Standing as a "reminder of past glories of one of the world's greatest civilisations," the Wall is equipped with museums, forts, and events that bring Roman history to life. Designed by the World Heritage Site, this Web site offers tourist information (such as travel and hotel arrangements) for anyone interested in visiting this historical landmark that ranks along with the great wonders of the world.



Myocardial viability assessment in 18FDG PET/CT study (18FDG PET myocardial viability assessment).  


Accurate identification of viable myocardium is crucial in patient qualification for medical or surgical treatment. Only persons with confirmed cardiac viability will benefit from revascularization procedures. It is also well known, that the amount of viable myocardium assessed preoperatively is the best indicator of long term cardiac event free survival after cardiac intervention.There are several diagnostic approaches used in current clinical practice for assessment of myocardial viability. Analysis of wall thickness or myocardial contraction, evaluation of cardiac perfusion or metabolism can be assessed using following modalities: Echocardiography, Cardiac Molecular Imaging techniques (PET, SPECT), Cardiovascular MR or Cardiovascular CT. The article describes the methods and problems of viability assessment in 18FDG PET study. PET imaging has proved its accuracy and reproducibility for myocardial ischemia and viability assessment. However this unique in its ability for showing the particular substrate metabolism technique has unfortunately some disadvantages: currently achieved PET resolution is 0.4 cm. However the combined devices multislice computed tomography scanners with PET (PET/CT) are now widely used in clinical practice. This combination allows for wider morphologic assessments: coronary calcium scoring and non-invasive coronary angiography may be added to myocardial perfusion/metabolic imaging if necessary. PMID:23047574

Kobylecka, Ma?gorzata; M?czewska, Joanna; Fronczewska-Wieniawska, Katarzyna; Mazurek, Tomasz; P?azi?ska, Maria Teresa; Królicki, Leszek



The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia  

PubMed Central

Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto, Siemens Medical Systems). Three short-axis cine and grid series were acquired during rest and at increasing doses of dobutamine (maximum 40 ?g/kg/min). On peak dose dobutamine followed immediately by a first pass myocardial perfusion imaging sequence. Images were graded according to the sixteen-segment model, on a four point scale. Ninety-seven patients showed no New (Induced) Wall Motion Abnormalities (NWMA). Perfusion imaging showed absence of perfusion deficits in 67 of these patients (69%). Perfusion deficits attributable to known previous myocardial infarction were found in 30 patients (31%). Eighteen patients had NWMA, indicative for myocardial ischemia, of which 14 (78%) could be confirmed by a corresponding perfusion deficit. Four patients (22%) with NWMA did not have perfusion deficits. In these four patients NWMA were caused by a Left Bundle Branch Block (LBBB). They were free from cardiac events during the follow-up period (median 13.5 months; range 6–20). Addition of first-pass myocardial perfusion imaging during peak-dose dobutamine stress CMR can help to decide whether a NWMA is caused by myocardial ischemia or is due to an (inducible) LBBB, hereby preventing a false positive wall motion interpretation.

Janssen, Caroline H. C.; Kuijpers, Dirkjan; van Dijkman, Paul R. M.; Overbosch, Jelle; Willems, Tineke P.; Oudkerk, Matthijs



ECG findings after myocardial infarction in children after Kawasaki disease  

SciTech Connect

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.

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



JAMA Patient Page: Myocardial Infarction  


... of the American Medical Association JAMA PATIENT PAGE Myocardial Infarction M yocardial infarction , also known as a heart attack, can strike without warning. A myocardial infarction occurs when blood supply to a part of ...


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

SciTech Connect

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.

Abegunewardene, Nico, E-mail:; Vosseler, Markus; Gori, Tommaso [Johannes Gutenberg-University Mainz, Second Medical Clinic (Germany); Hoffmann, Nico [Johannes Gutenberg-University Mainz, Section of Medical Physics (Germany); Schmidt, Kai-Helge; Becker, Dietmar [Johannes Gutenberg-University Mainz, Second Medical Clinic (Germany); Kreitner, Karl-Friedrich [Johannes Gutenberg-University Mainz, Clinic for Radiology (Germany); Petersen, Steffen E. [John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR) (United Kingdom); Schreiber, Laura M. [Johannes Gutenberg-University Mainz, Section of Medical Physics (Germany); Horstick, Georg; Muenzel, Thomas [Johannes Gutenberg-University Mainz, Second Medical Clinic (Germany)



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

SciTech Connect

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.

Marwick, T.H.; Hollman, J. (Cleveland Clinic Foundation, OH (USA))



Traumatic abdominal wall hernia  

PubMed Central

INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.

Yadav, Siddharth; Jain, Sunil K.; Arora, Jainendra K.; Sharma, Piyush; Sharma, Abhinav; Bhagwan, Jai; Goyal, Kaushal; Sahoo, Bhabani S.



Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy.  


A case of combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy is reported. The paresis possibly occurred by a lesion of the N. intercostalis when extending the incision for stone extraction. Possibly the paresis was a predisposing factor for the development of an incisional hernia. The causes of abdominal wall paresis are explored with a review of the literature. In spite of minimal trauma to the anterior abdominal wall in laparoscopic procedures, the risk of iatrogenic lesions remains. PMID:10064761

Korenkov, M; Rixen, D; Paul, A; Köhler, L; Eypasch, E; Troidl, H



Wall Art  

ERIC Educational Resources Information Center

|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…

McGinley, Connie Q.



A neurosurgical view of anatomical evaluation of anterior C1-C2 for safer transoral odontoidectomy.  


An anatomical study for evaluation of anterior C1-C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approach for odontoidectomy have been described in detail. Anterior arcus of C1 must be drilled out to reach odontoid process for transoral odontoidectomy. The thickness of anterior ring of C1 has not been studied before. Sixty, dried adult atlas and 60 axis vertebrae and ten cadaveric craniocervical specimens were measured for the following: (1) bony drilling depth (BDD), the distance from the anterior wall of anterior ring of C1 to anterior wall of odontoid; (2) minimum drilling diameter (MDD), distance of minimum C1 anterior ring removal for odontoid resection on horizontal plane; (3) maximum bony drilling diameter (MBDD), distance of maximum C1 anterior ring removal for odontoid resection on horizontal plane. Lateral border of this diameter is limited by medial borders of the lateral mass; (4) the widest odontoid diameters (WOD) on coronal sections were measured. On 60 atlas and axis vertebrae, the BDD was 7.0 +/- 1.2 mm on dry bones, the distance between the medial borders of the lateral mass (MBDD) was 16.1 +/- 1.5 mm, and the WOD on coronal sections (WOD) was 9.8 +/- 0.8 mm. On cadavers, the distance between the two edges of C1 anterior ring removal for odontoid resection (MDD) was 10.8 +/- 1.1 mm and the WOD on coronal sections (WOD) was 10.1 +/- 1.4 mm. An odontoid surgery through transoral approach is safe and feasible. A quantitative understanding of the anterior anatomy of C-1 and C-2 is necessary when considering transoral odontoid resection. In this study the authors define safe zones for anterior atlas and axis. PMID:18351401

Tun, Kagan; Kaptanoglu, Erkan; Cemil, Berker; Karahan, S Tuna; Esmer, Ali Firat; Elhan, Alaiddin



Clinical implications of increased lung uptake of ²°¹Tl during exercise scintigraphy 2 weeks after myocardial infarction  

Microsoft Academic Search

To determine the prevalence and clinical significance of increased lung ²°¹Tl uptake during submaximal exercise myocardial scintigraphy performed 2 weeks after acute myocardial infarction, 61 patients underwent submaximal exercise testing (target heart rate, 120 beats\\/min), multigated blood pool imaging at rest and coronary angiography before hospital discharge. Thallium lung uptake on the initial anterior projection image was graded qualitatively by

Robert S. Gibson; Denny D. Watson; Blase A. Carabello; Nina D. Holt; George A. Beller



Evaluation of Right Ventricular Contraction by Myocardial Strain in Children Using a Two-Dimensional Tissue Tracking Method  

Microsoft Academic Search

Two-dimensional tissue tracking makes it possible to detect myocardial strain in any direction. Consequently, this method\\u000a is applicable for evaluation of myocardial dyssynchrony. This study enrolled 22 healthy volunteers (11 boys and 11 girls)\\u000a ages 1.6 to 10.8 years (mean, 6.8 years). Echocardiography (subxiphoid right anterior oblique view) of the right ventricle\\u000a was examined. Three tracking points were put on

H. Matsui; G. Satomi; S. Yasukochi; S. Kaneko; K. Haseyama



Anterior Lumbar Interbody Fusion (ALIF)  

Microsoft Academic Search

\\u000a Anterior lumbar interbody fusion (ALIF) is a method of achieving intersegmental arthrodesis that is indicated for the treatment\\u000a of symptomatic degenerative disease [1, 2]. While ALIF has use for indications involving multiple levels and complex combinations\\u000a of anterior and posterior instrumentation, fusions for degenerative and deformity cases, spondylolisthesis [3, 4], and failed\\u000a posterior surgery with pseudoarthroses, a common indication remains

Henry E. Aryan; Sigurd H. Berven; Christopher P. Ames


Improved myocardial performance induced by clofibrate during reperfusion after acute myocardial infarction.  


The increase of cellular fatty acids appears to be one of the causes of the myocardial injury during ischemia and reperfusion. This study was designed to examine whether a hypolipidemic drug such as clofibrate can reduce the myocardial injury during ischemia and reperfusion. Clofibrate was fed to experimental pigs for 9 days. Isolated in situ hearts from both experimental and control pigs were subjected to 60 min of regional ischemia induced by occluding the left anterior descending coronary artery, followed by 60 min of global ischemia by hypothermic cardioplegic arrest and 60 min of reperfusion. The clofibrate feeding resulted in the better cardiac performance as judged by increased coronary blood flow, improved left ventricular function, and reduced myocardial injury as judged by creatine kinase release. Although the clofibrate-fed animals contained higher levels of thiobarbituric reactive materials, the free fatty acid levels of plasma and myocardium were much lower compared with control animals. The clofibrate feeding was also associated with increased peroxisomal catalase and beta-oxidation of fatty acids. These results suggest that decreased levels of free fatty acids in the plasma and the myocardium and increased catalase activity induced by antilipolytic therapy appear to provide beneficial effects to the myocardium during ischemia and reperfusion. PMID:3228787

Prasad, M R; Clement, R; Otani, H; Jones, R; Das, D K; Engelman, R M; Breyer, R H; Rousou, J A



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

NASA Astrophysics Data System (ADS)

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.

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



Nonsurgical reperfusion in evolving myocardial infarction  

SciTech Connect

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.

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



Carotid intima-media thickness in young survivors of acute myocardial infarction  

PubMed Central

BACKGROUND: Carotid intima-media thickness (CIMT) is considered to be a useful surrogate marker of coronary atherosclerosis. However, it is unclear whether this applies to young patients with acute myocardial infarction (AMI), in whom most cases are attributable to the destabilization of focal atheroma. OBJECTIVE: To assess CIMT in patients experiencing AMI at a young age. METHODS: CIMT was investigated in young survivors of AMI (78 male and 20 female) occurring before 45 years of age in men and before 50 years of age in women. CIMT values were compared with those of a sex-, age- and smoking status-matched sample selected from participants of a large epidemiological survey (115 men and 144 women). CIMT was measured on the anterior and posterior walls of the distal common carotid artery. RESULTS: In post-AMI male patients, the mean average CIMT, comprised of measurements of both the near and far walls on both sides, was significantly increased compared with controls (0.67±0.10 mm versus 0.60±0.09 mm; P<0.001), while it did not differ in post-AMI female patients (0.60±0.07 mm versus 0.60±0.10 mm). Mean maximum CIMT was greater in both male and female post-AMI patients (0.94±0.15 mm versus 0.81±0.13 mm; P<0.001 in men and 0.89±0.14 mm versus 0.80±0.11 mm; P=0.001 in women). CONCLUSIONS: In young AMI survivors, CIMT appeared to be significantly increased to a greater extent in men than in women. Although most patients had single- or double-vessel coronary disease, the overall increase in CIMT suggests that their coronary events were not due to destabilization of a single focal atheroma but may have reflected a generalized atherosclerotic process.

Linhart, Ales; Dostalova, Gabriela; Belohlavek, Jan; Vitek, Libor; Karetova, Debora; Ingrischova, Michaela; Bojanovska, Kristina; Polacek, Pavel; Votavova, Regina; Cifkova, Renata



Swine experimental model to evaluate stem cells implant post myocardial infarction by perfusion gated-SPET.  


Autologous bone marrow stromal cells (BMSC) implant after swine experimental myocardial infarct (MI) was investigated by serial technetium-99m ((99m)Tc)-tetrofosmin gated single photon emission tomography (G-SPET) and compared with immuno-histochemical findings. The aim was to evaluate if intramyocardial BMSC implant produces any prolonged effect in the left ventricle (LV) perfusion and function. Eleven pigs underwent left anterior descending artery (LAD) ligature; in seven of them BMSC were injected in the border zone of the MI, while in the remaining four saline solution was injected at the same site. After LAD ligature G-SPET scans at 48h and at 5 and 10 weeks (w) after the implant were performed. Uptake defect size and LV function analysis were performed comparing 48h to 5w and 10w studies. Statistical evaluation was performed with Friedman test and unpaired Wilcoxon test. The comparison between a progressive reduction of Perfusion Image Score was observed from 48h to 5w and to 10w in the treated group (Friedman test: ?²= 13.56; P=0.01). No variation was observed in the control group (Friedman test: ?²=3; P= 0.223). Comparison of the absolute variation (?) between treated and control group resulted significant (Wilcoxon test W=10; P=0.007). Similar positive results were also observed for the relative extension of the uptake defect, wall motion and LVEF analysis. Histological data of our swine model demonstrated that autologous BMSC implanted in the damaged myocardium area had survived and differentiated into cells with typical features of myocardiocytes. Gated SPET is a reliable tool to evaluate prolonged positive effects of autologous BMSC implant in swine experimental MI model. In conclusion, autologous BMSC implanted can improve perfusion, induce cell regeneration, reduce wall motion abnormalities and prevent severe LV dysfunction in swines. PMID:22413107

Niccoli-Asabella, Artor; Ferlan, Giovanni; Crovace, Antonio; Notaristefano, Antonio; Rubini, Domenico; Altini, Corinna; Pisani, Antonio; Rubini, Giuseppe


A Novel Stress Echocardiography Pattern for Myocardial Bridge With Invasive Structural and Hemodynamic Correlation  

PubMed Central

Background Patients with a myocardial bridge (MB) and no significant obstructive coronary artery disease (CAD) may experience angina presumably from ischemia, but noninvasive assessment has been limited and the underlying mechanism poorly understood. This study seeks to correlate a novel exercise echocardiography (EE) finding for MBs with invasive structural and hemodynamic measurements. Methods and Results Eighteen patients with angina and an EE pattern of focal end?systolic to early?diastolic buckling in the septum with apical sparing were prospectively enrolled for invasive assessment. This included coronary angiography, left anterior descending artery (LAD) intravascular ultrasound (IVUS), and intracoronary pressure and Doppler measurements at rest and during dobutamine stress. All patients were found to have an LAD MB on IVUS. The ratios of diastolic intracoronary pressure divided by aortic pressure at rest (Pd/Pa) and during dobutamine stress (diastolic fractional flow reserve [dFFR]) and peak Doppler flow velocity recordings at rest and with stress were successfully performed in 14 patients. All had abnormal dFFR (?0.75) at stress within the bridge, distally or in both positions, and on average showed a more than doubling in peak Doppler flow velocity inside the MB at stress. Seventy?five percent of patients had normalization of dFFR distal to the MB, with partial pressure recovery and a decrease in peak Doppler flow velocity. Conclusions A distinctive septal wall motion abnormality with apical sparing on EE is associated with a documented MB by IVUS and a decreased dFFR. We posit that the septal wall motion abnormality on EE is due to dynamic ischemia local to the compressed segment of the LAD from the increase in velocity and decrease in perfusion pressure, consistent with the Venturi effect.

Lin, Shin; Tremmel, Jennifer A.; Yamada, Ryotaro; Rogers, Ian S.; Yong, Celina Mei; Turcott, Robert; McConnell, Michael V.; Dash, Rajesh; Schnittger, Ingela



Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction.  


OBJECTIVES: We investigated the correlation between left ventricular global and regional longitudinal systolic strain (GLS and LRS) and coronary flow reserve (CFR) assessed by transthoracic echocardiography (TTE) in patients with a recent acute myocardial infarction (AMI). Furthermore, we investigated if LRS and GLS imaging is superior to conventional measures of left ventricle (LV) function. Methods: In a consecutive population of first time AMI patients, who underwent successful revascularization, we performed comprehensive TTE. GLS and LRS were obtained from the three standard apical views. Assessment of CFR by TTE was performed in a modified apical view using color Doppler guidance. Results: The study population consisted of 183 patients (51 females) with a median age of 63 [54;70] years. Eighty-nine (49%) patients had a non-ST elevation myocardial infarction and 94 (51%) patients had a ST elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1.86 [1.36;2.35] and the GLS was -14.3 [-18.9; -9.8]%. A significant difference was observed in the LRS in LAD territory in culprit LAD infarction patients with a CFR ? 2 (-9.6 [-13.77;-6.44]) compared with the LRS in LAD territory in culprit LAD infarction patients with a CFR > 2 (-19.33 [-21.1;-16.5]), P < 0.0001. We found no significant difference between WMSI in LAD territory in culprit LAD infarction patients with a CFR ? 2 (1.56 [1.06;2.23]) compared with WMSI in LAD territory in culprit LAD infarction patients with a CFR > 2 (1.37 [1.03;2.11]); P = 0.18. The same pattern was observed in both circumflex coronary artery (CX) and right coronary artery (RCA) territories. In the total population, we found a strong correlation between CFR and GLS (r = -0.85, P < 0.0001). This was also seen in the multivariate regression model adjusting for possible confounders including WMSI (P < 0.001). CONCLUSION: In this study, we have shown a close association between myocardial deformation in patients with a recent AMI and the degree of diminished microcirculation. We found that both GLS and LRS correlated with CFR. We conclude that GLS and LRS are significantly better tools to assess impaired CFR and LV function after a recent AMI, than conventional echocardiographic measurements. PMID:22862151

Løgstrup, Brian B; Høfsten, Dan E; Christophersen, Thomas B; Møller, Jacob E; Bøtker, Hans E; Pellikka, Patricia A; Egstrup, Kenneth



Myocardial diseases of animals.  

PubMed Central

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

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



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

SciTech Connect

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.

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



Sutureless patch repair for small blowout rupture of the left ventricle after myocardial infarction  

Microsoft Academic Search

Rupture of the left ventricular free wall is one of the most serious complications of myocardial infarction. A 73-year-old\\u000a man with severe chest pain visited our hospital. Coronary angiography revealed acute myocardial infarction in the territory\\u000a of the diagonal branch. About six hours after successful percutaneous coronary intervention, the patient fell into cardiogenic\\u000a shock with chest pain. Echocardiography showed moderate

Kazuhiko Nishizaki; Toshio Seki; Atsushi Fujii; Yasunori Nishida; Masafumi Funabiki; Yoshinobu Morikawa



Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device  

PubMed Central

Myocardial bridging is a common coronary anomaly, which is generally described as a benign phenomenon. However, a growing number of studies consider this anomaly a relevant pathophysiological phenomenon with serious pathological consequences. Here we report on the case of an 88-year-old woman suffering from myocardial infarction and ventricular septal rupture, lacking any recognizable coronary disease except for a myocardial bridge causing the systolic compression of the left anterior descending coronary artery. A wide range of diagnostic procedures, including coronarography, echocardiography, and magnetic resonance imaging were used. The septal rupture was finally closed by using a percutaneous closure device. This event indicates that myocardial bridges – at least in some cases – may have notable clinical relevance.

Zoka, Andras; Andreka, Peter; Becker, David; Fontos, Geza; Merkely, Bela; Szabo, Gyorgy; Szatmari, Andras; Barczi, Gyorgy



Association of myocardial bridge and Takotsubo cardiomyopathy: a case report and literature review.  


A woman presented with chest pain following emotional stress. Investigations showed acute ST-segment elevation, myocardial infarction, and elevated serum troponin. Emergency heart catheterization showed left anterior descending artery myocardial bridging, apical ballooning consistent with takotsubo cardiomyopathy (TTC), and decreased ejection fraction. Two days later, echocardiogram demonstrated near normalization of ventricular function.The etiology of TTC is not known but may include a stress-related surge of catecholamines or epicardial coronary spasm. Other case series reported an association of myocardial bridge and TTC. Catecholamines surge during stress might contribute to both diseases resulting in an apparent association; alternatively, a symptomatic myocardial bridge may be a contributing factor in worsening TTC. PMID:19668047

Boktor, Moheb; Mansi, Ishak A; Troxclair, Sean; Modi, Kalgi



Reoperation for myocardial revascularization  

Microsoft Academic Search

At The Cleveland Clinic Foundation, reoperations for myocardial revascularization make up 2.7% of all cardiac operations. Major indications for reoperation include: (a) graft failure, (b) progressive atherosclerosis in grafted or ungrafted vessels, (c) previous incomplete revascularization, and (d) combinations of the other 3. Almost one-half of the candidates satisfy more than 1 of the first 3 indications. Although few in

Floyd D. Loop; Robert L. Thurer; Bruce W. Lytle; Delos M. Cosgrove



Multidetector-row computed tomographic evaluation of myocardial perfusion in reperfused chronic myocardial infarction: value of color-coded perfusion map in a porcine model  

Microsoft Academic Search

We aimed to develop color-coded CT perfusion maps (CPM) of infarcted myocardium and assess the utility of CPM in evaluating\\u000a ischemic heart disease on a cardiac multi-detector CT (MDCT) in a porcine reperfused-myocardial-infarction model. Myocardial\\u000a infarctions were induced by 30 min occlusions of the proximal left anterior descending coronary artery (LAD) in 17 healthy\\u000a adult female pigs. First-pass and 5 min-delayed cardiac

Nam Yeol Yim; Yun-Hyeon Kim; Song Choi; Hyun Ju Seon; Yeong Cheol Kim; Gwang Woo Jeong; Byeong In Min; Sang Rok Lee; Myeong Ho Jeong; Jae Kyu Kim; Jin Gyoon Park; Heoung Keun Kang



Spontaneous and simultaneous multivessel coronary spasm causing multisite myocardial infarction, cardiogenic shock, atrioventricular block, and ventricular fibrillation.  


A 57-year-old Taiwanese man with a past history of variant angina developed simultaneous anterior and inferior myocardial infarction, atrioventricular block, cardiogenic shock, and eventually ventricular fibrillation. Left coronary angiography revealed simultaneous occlusion of the left anterior descending and the left circumflex coronary arteries, which was relieved by intracoronary administration of isosorbide dinitrate. This is the first report of such a case in the English-language medical literature. PMID:19179777

Chuang, Yao-Tsung; Ueng, Kwo-Chang



Anterior Orbit and Adnexal Amyloidosis  

PubMed Central

Purpose: To describe six cases of anterior orbital and adnexal amyloidosis and to report on proteomic analysis to characterize the nature of amyloid in archived biopsies in two cases. Materials and Methods: The clinical features, radiological findings, pathology, and outcome of six patients with anterior orbit and adnexal amyloidosis were retrieved from the medical records. The biochemical nature of the amyloid was determined using liquid chromatography/mass spectroscopy archived paraffin-embedded tissue in two cases. Results: Of the six cases, three had unilateral localized anterior orbit and lacrimal gland involvement. Four of the six patients were female with an average duration of 12.8 years from the time of onset to presentation eyelid infiltration by amyloid caused ptosis in five cases. CT scan in patients with lacrimal gland involvement (n = 3) demonstrated calcified deformable anterior orbital masses and on pathological exmaintionamyloid and calcific deposits replaced the lacrimal gland acini. Ptosis repair was performed in three patients with good outcomes. One patient required repeated debulking of the mass and one patient had recurrenct disease. Proteomic analysis revealed polyclonal IgG-associated amyloid deposition in one patient and AL kappa amyloid in the second patient. Conclusion: Amyloidosis of the anterior orbit and lacrimal gland can present with a wide spectrum of findings with good outcomes after surgical excision. The nature of amyloid material can be precisely determined in archival pathology blocks using diagnostic proteomic analysis.

Al Hussain, Hailah; Edward, Deepak P.



Reverse redistribution of Tc99m-tetrofosmin in patients with acute myocardial infarction  

Microsoft Academic Search

We examined reverse redistribution (RR) of Tc-99m-tetrofosmin after a single injection in patients with acute myocardial infarction\\u000a (AMI). Tc-99m-tetrofosmin myocardial SPECT was performed in 28 patients with AMI 10–14 days after the onset. Myocardial images\\u000a were obtained 30 min and 180 min after the injection of 740 MBq of Tc-99m-tetrofosmin. The left ventricular wall was divided\\u000a into 9 segments. Regional

Hiroki Sugihara; Tatsuya Nakagawa; Eiko Yamashita; Noriyuki Kinoshita; Kazuki Ito; Akihiro Azuma; Chio Okuyama; Yo Ushijima; Masao Nakagawa; Tomoho Maeda



Effect of reperfusion and hyperemia on the myocardial distribution of technetium-99m t-butylisonitrile  

SciTech Connect

Technetium-99m t-butylisonitrile ((/sup 99m/Tc)TBI) is a promising new radiotracer for myocardial imaging. Its myocardial uptake is sufficiently high in humans to permit planar, tomographic, and gated images of excellent technical quality. We studied the behavior of (/sup 99m/Tc)TBI in the dog at rest and under conditions of hyperemia and reperfusion in order to determine the relationship between (/sup 99m/Tc)TBI myocardial concentration and blood flow. After permanent occlusion of the left anterior descending artery, the correlation between the relative myocardial concentration of (/sup 99m/Tc)TBI and regional myocardial blood flow (RMBF) measured with radiolabeled microspheres was excellent. In a dog model of transient hyperemia, the concentration of (/sup 99m/Tc)TBI was directly related to blood flow but underestimated the degree of hyperemia. Technetium-99m TBI redistributed into transiently ischemic myocardium. The myocardial concentrations of (/sup 99m/Tc)TBI and thallium-201(/sup 201/TI) in transiently ischemic myocardium were similar at 10 and 30 min following reperfusion and were significantly higher than blood flow prior to reperfusion. When (/sup 99m/Tc)TBI was injected into the left anterior descending artery, the washout was slow, falling to 78% of initial activity at 120 min after injection. In conclusion, (/sup 99m/Tc)TBI reflects regional myocardial blood flow accurately in ischemic and normal resting myocardium and underestimates blood flow at high flows. The rate of myocardial redistribution after reperfusion is similar for (/sup 99m/Tc)TBI and /sup 201/TI.

Holman, B.L.; Campbell, C.A.; Lister-James, J.; Jones, A.G.; Davison, A.; Kloner, R.A.



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

SciTech Connect

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.

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



Concentrated Ambient Particles Alter Myocardial Blood Flow during Acute Ischemia in Conscious Canines  

PubMed Central

Background Experimental and observational studies have demonstrated that short-term exposure to ambient particulate matter (PM) exacerbates myocardial ischemia. Objectives We conducted this study to investigate the effects of concentrated ambient particles (CAPs) on myocardial blood flow during myocardial ischemia in chronically instrumented conscious canines. Methods Eleven canines were instrumented with a balloon occluder around the left anterior descending coronary artery and catheters for determination of myocardial blood flow using fluorescent microspheres. Telemetric electrocardiographic and blood pressure monitoring was available for four of these animals. After recovery, we exposed animals by inhalation to 5 hr of either filtered air or CAPs (mean concentration ± SD, 349.0 ± 282.6 ?g/m3) in a crossover protocol. We determined myocardial blood flow during a 5-min coronary artery occlusion immediately after each exposure. Data were analyzed using mixed models for repeated measures. The primary analysis was based on four canines that completed the protocol. Results CAPs exposure decreased total myocardial blood flow during coronary artery occlusion by 0.12 mL/min/g (p < 0.001) and was accompanied by a 13% (p < 0.001) increase in coronary vascular resistance. Rate–pressure product, an index of myocardial oxygen demand, did not differ by exposure (p = 0.90). CAPs effects on myocardial blood flow were significantly more pronounced in myocardium within or near the ischemic zone versus more remote myocardium (p interaction < 0.001). Conclusions These results suggest that PM exacerbates myocardial ischemia by increased coronary vascular resistance and decreased myocardial perfusion. Further studies are needed to elucidate the mechanism of these effects.

Bartoli, Carlo R.; Wellenius, Gregory A.; Coull, Brent A.; Akiyama, Ichiro; Diaz, Edgar A.; Lawrence, Joy; Okabe, Kazunori; Verrier, Richard L.; Godleski, John J.



Giant anterior mediastinal parathyroid adenoma.  


A 57-year-old woman with type 2 diabetes was admitted to our hospital presenting with generalized bone pains, hypercalcemia, and elevated parathyroid hormone level. Enhanced CT scan demonstrated a large soft tissue mass in the right anterior mediastinum. Tc-MIBI scintigraphy revealed the focal accumulation of radiotracer uptake in the anterior mediastinum. Tc-MIBI SPECT/CT imaging also corroborated the same finding. The patient underwent surgery to have a giant ectopic parathyroid adenoma (7 × 4.5 × 1.5 cm) removed. The patient has been observed for 2 years, with normal parathyroid hormone and calcium levels. PMID:22889780

Li, Lianxi; Chen, Libo; Yang, Yi; Han, Junfeng; Wu, Songhua; Bao, Yuqian; Jia, Weiping



Coronary hyperperfusion and myocardial metabolism in isolated and intact hearts  

SciTech Connect

The authors determined the independent influence of coronary hyperperfusion on myocardial metabolism in isolated and intact hearts. In an isovolumic blood-perfused rat heart preparation working against a left ventricular (LV) balloon, the effect of increasing coronary perfusion pressure from 100 to 150 mmHg was assessed. They concluded that coronary hyperperfusion was not an independent stimulus to myocardial VO{sub 2}. To further test this, the effect of coronary hyperperfusion on myocardial metabolism was studied in an intact working swine heart preparation where the cardiac output was fixed with a right heart bypass circuit. Fatty acid oxidation in the left anterior descending bed was assessed by production of {sup 14}CO{sub 2} from ({sup 14}C(U))palmitate. They conclude that coronary hyperperfusion is not an independent determinant of myocardial oxidation or fatty acid utilization, and enhancement of mechanical function by the garden-hose effect appears to be dependent on the parameters of LV performance that are controlled.

Miller, W.P.; Shimamoto, N.; Nellis, S.H.; Liedtke, A.J. (Univ. of Wisconsin Medical School, Madison (USA))



Myocardial metabolism during hypoxia: Maintained lactate oxidation during increased glycolysis  

SciTech Connect

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.

Mazer, C.D.; Stanley, W.C.; Hickey, R.F.; Neese, R.A.; Cason, B.A.; Demas, K.A.; Wisneski, J.A.; Gertz, E.W. (Univ. of California, San Francisco (USA))



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

PubMed Central

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.

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



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


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) ½ 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

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



Cooling wall  

SciTech Connect

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.

Nosenko, V.I. [Triangle Trading and Technology Corp., Laguna Hills, CA (United States)



Access related complications during anterior exposure of the lumbar spine  

PubMed Central

The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation (non-fusion) technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimally invasive surgical therapies of the lumbar spine. While injury to the major vascular structures remains the most serious and feared complication of the anterior approach, this occurrence has been nearly eliminated by the use of lateral based approaches for discectomy and fusion cephalad to L5-S1. Whether anterior or lateral based, non-posterior approaches to the lumbar spine share certain access related pitfalls and complications, including damage to the urologic and neurologic structures, as well as gastrointestinal and abdominal wall issues. This review will focus on the recognition, management and prevention of these anterior and lateral access related complications.

Fantini, Gary A; Pawar, Abhijit Y



Wandering Ascaris Coming Out Through the Abdominal Wall  

PubMed Central

A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12th postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here.

Wani, Mohd L; Rather, Ajaz A.; Parray, Fazl Q.; Ahangar, Abdul G.; Bijli, Akram H.; Irshad, Ifat; Nayeem-Ul-Hassan; Khan, Tahir S.



Pericardial Involvement in Diseases of the Heart and Other Contiguous Structures: Part I – Pericardial Involvement in Infarct Pericarditis and Pericardial Involvement following Myocardial Infarction  

Microsoft Academic Search

Active contiguous abnormalities can frequently involve the pericardium. Prominent among these are cardiac conditions which encroach on the pericardium, particularly transmural myocardial infarction (newly always with Q-waves). Complications of infarctions, notably myocardial pseudoaneurysm, have one wall which is pericardium. Furthermore, dissecting aneurysm of the aorta and the intramural aortic hemorrhage may rupture into the pericardium with tamponade, or, if limited,

Raman Mehrzad; David H. Spodick



Perfusion MRI at rest in subacute and chronic myocardial infarct.  


BackgroundPerfusion magnetic resonance imaging (MRI) and delayed contrast-enhanced MRI (DE-MRI) serve as tools for tissue characterization.PurposeTo assess and compare semi-quantitative parameters of myocardial infarct (MI) in the subacute and chronic phase, and to correlate these parameters with qualitative enhancement analysis.Material and MethodsPerfusion MRI at rest and DE-MRI were performed in 63 patients with anterior wall MI at 2-3 weeks after revascularization and repeated after 6 months. Descriptive enhancement parameters of contrast arrival time, initial upslope, enhancement at normal tissue peak (TTP(n)) and wash-out slope, and kinetic tissue parameters rBF, K(trans), k(ep) and v(e) were calculated. Subacute infarct tissue was compared to normal myocardium and chronic infarct tissue. Patients were stratified at baseline according to a qualitative grading of hypoenhancement based on first-pass enhancement and presence of microvascular obstruction (MO) at perfusion MRI and on persistent MO at DE-MRI. The qualitative grade was correlated to semi-quantitative perfusion MRI parameters.ResultsInitial upslope, enhancement at TTPn, rBF, and k(ep) were decreased and wash-out slope and v(e) were increased in infarct tissue (P < 0.001 for all analyses). Infarct tissue v(e) decreased from baseline to 6 months (P = 0.045). At baseline infarct tissue with persistent MO revealed decreased K(trans) and delayed contrast arrival, and more pronounced decrease of enhancement at TTPn, rBF and k(ep) compared to other enhancement groups (P < 0.008 for pairwise analyses).ConclusionPerfusion is decreased in subacute reperfused infarct tissue compared to normal tissue. K(trans) is not decreased, consistent with increased surface area of the vascular bed of the subacute infarct. Infarct tissue v(e) is increased, and decreases with scarring. The presence of persistent MO correlates to more pronounced perfusion reduction and results in delayed contrast arrival, indicating microvascular collateral circulation. PMID:23401603

Hopp, Einar; Bjørnerud, Atle; Lunde, Ketil; Solheim, Svein; Aakhus, Svend; Arnesen, Harald; Forfang, Kolbjørn; Edvardsen, Thor; Smith, Hans-Jørgen



Subcutaneous anterior hairline forehead rhytidectomy  

Microsoft Academic Search

An anterior hairline incision with subcutaneous (superficial to the frontalis muscle) dissection is recommended for certain categories of rhytidectomy patients. Patient selection is a very important preoperative procedure. The technique and results are described and illustrated. Advantages and disadvantages are discussed.

Bahman Guyuron; Brian Davies