Sample records for left cardiac chambers

  1. Evaluation of the Effect of Cardiac Rehabilitation on Left Ventricular Diastolic and Systolic Function and Cardiac Chamber Size in Patients Undergoing Percutaneous Coronary Intervention

    PubMed Central

    Soleimannejad, Kourosh; Nouzari, Younos; Ahsani, Alireza; Nejatian, Mostafa; Sayehmiri, Kourosh

    2014-01-01

    Abstract Background: Exercise and rehabilitation are important methods for decreasing the risk factors of coronary artery disease (CAD). We aimed to evaluate the effect of the cardiac rehabilitation (CR) exercise program on the cardiac structure and physiology in patients undergoing percutaneous coronary intervention (PCI). Methods: In this randomized controlled study, 146 patients with CAD were divided equally into two groups: case group (undertaking CR after PCI) and control group (without rehabilitation after PCI). All the patients in the case group underwent echocardiography (before and after CR), and echocardiography was performed for the control group simultaneously. The CR exercise program encompassed 24 sessions, twice or three times a week, with each session lasting between 15 and 45 minutes, depending on the individual patient’s tolerance. Left ventricular (LV) ejection fraction, LV diastolic function, LV end-systolic and diastolic diameter, and right ventricular (RV) end-diastolic diameter were measured in the CR group before and after rehabilitation and compared to those in the control group at the same times. Results: In this study, 146 patients (46 female and 100 male) were evaluated: 73 in the rehabilitation group and 73 in the control group. The mean age of the patients in the CR and control groups was 58.05 ± 10.27 and 56.76 ± 10.07 years, respectively. The CR exercise program had useful effects on LV diastolic function after PCI. The distribution of LV diastolic dysfunction after the CR exercise program was changed significantly only in the CR group (p value = 0.043). In the CR group, normal, grade I, grade II, and grade III LV diastolic dysfunction were observed in 20.5%, 69.8%, 6.8%, and 2.7%, respectively. This distribution was changed respectively to 30.1%, 61.6%, 5.4%, and 2.7% following CR, which showed a significant improvement due to CR in LV diastolic function, most prominently in the patients with grade I diastolic dysfunction (p value = 0.390). There was no significant change in LV and RV diameter before and after rehabilitation, while the ejection fraction increased significantly (p value < 0.05) in both groups. Conclusion: The RC exercise program can be effective in the augmentation of LV diastolic dysfunction after PCI, without significant changes in LV diameters.

  2. Cardiac ventricular chambers are epigenetically distinguishable.

    PubMed

    Mathiyalagan, Prabhu; Chang, Lisa; Du, Xiao-Jun; El-Osta, Assam

    2010-02-01

    The left and right ventricles are muscular chambers of the heart that differ significantly in the extent of pressure work-load. The regional and differential distribution of gene expression patterns is critical not only for heart development, but, also in the establishment of cardiac hypertrophy phenotypes. the cells of the myocardium employ elaborate regulatory mechanisms to establish changes in chromatin structure and function, yet, the role of epigenetic modifications and specific gene expression patterns in cardiac ventricles remains poorly understood. We have examined gene expression changes and studied histone H3 and H4 acetylation as well as dimethylation of lysine 4 on histone H3 on promoters of alpha-Myosin heavy chain gene (alpha-MHC), beta-Myosin heavy chain gene (beta-MHC), Atrial natriuretic peptide gene (ANp), B-type natriuretic peptide gene (BNP) and Sarcoplasmic reticulum Ca(2+) ATPase gene (SERCA2a). The recruitment of histone acetyltransferase (HAT) enzyme p300, which is a transcriptional coactivator, was also studied on the hyperacetylated promoters using immunopurification of soluble chromatin in the left and right ventricles of the mouse. We present evidence for the first time that the pattern of gene expression is closely linked with histone modifications and propose the left and right chambers of the heart are epigenetically distinguishable. PMID:20090419

  3. VACTERL association with double-chambered left ventricle: A rare occurrence

    PubMed Central

    Al-Farqani, Abdulla; Panduranga, Prashanth; Al-Maskari, Salim; Thomas, Eapen

    2013-01-01

    VACTERL association is a non-random association of birth defects of unknown etiology derived from structures of embryonic mesoderm. The common cardiac defects seen with VACTERL association are ventricular septal defects, atrial septal defects, and tetralogy of Fallot. We present a 2-year-old child with VACTERL association in whom we detected double-chambered left ventricle on transthoracic echocardiography. PMID:24688248

  4. Cardiac Cell Culture Model (CCCM) as a Left Ventricle Mimic for Cardiac Tissue Generation

    PubMed Central

    Nguyen, Mai-Dung; Tinney, Joseph P.; Yuan, Fangping; Roussel, Thomas J.; El-Baz, Ayman; Giridharan, Guruprasad; Keller, Bradley B.; Sethu, Palaniappan

    2013-01-01

    A major challenge in cardiac tissue engineering is the delivery of hemodynamic mechanical cues that play a critical role in the early development and maturation of cardiomyocytes. Generation of functional cardiac tissue capable of replacing or augmenting cardiac function therefore requires physiologically relevant environments that can deliver complex mechanical cues for cardiomyocyte functional maturation. The goal of this work is the development and validation of a cardiac cell culture model (CCCM) microenvironment that accurately mimics pressure-volume changes seen in the left ventricle and to use this system to achieve cardiac cell maturation under conditions where mechanical loads such as pressure and stretch are gradually increased from the unloaded state to conditions seen in vivo. The CCCM platform, consisting of a cell culture chamber integrated within a flow loop was created to accomplish culture of 10 day chick embryonic ventricular cardiomyocytes subject to 4 days of stimulation (10 mm Hg, ~13% stretch at a frequency of 2 Hz). Results clearly show that CCCM conditioned cardiomyocytes accelerate cardiomyocyte structural and functional maturation in comparison to static unloaded controls as evidenced by increased proliferation, alignment of actin cytoskeleton, bundle-like sarcomeric ?-actinin expression, higher pacing beat rate at lower threshold voltages and increased shortening. These results confirm the CCCM microenvironment can accelerate immature cardiac cell structural and functional maturation for potential cardiac regenerative applications. PMID:23952579

  5. 12. DETAIL VIEW OF PODIUM, SENATE CHAMBER; MURAL TO LEFT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. DETAIL VIEW OF PODIUM, SENATE CHAMBER; MURAL TO LEFT DEPICTS 'FRANK P. BLAIR'S SPEECH AT LOUISIANA 1866' - Missouri State Capitol, High Street between Broadway & Jefferson Streets, Jefferson City, Cole County, MO

  6. Multimodality cardiac imaging of a double chambered right ventricle with intrapulmonary shunting: a case report

    PubMed Central

    2012-01-01

    Background Double chambered right ventricle (DCRV) is a relatively rare congenital heart disease, characterized by the abnormal division of the right ventricle into a high-pressure inlet and low-pressure outlet by anomalous muscle bundles. Extra-cardiac right-to-left shunts may present with clinical symptoms in adulthood and should be sought in patients with previous cavo-pulmonary shunt procedures. Case presentation We report a case of DCRV in a 29 year old Caucasian male presenting in adulthood with a right-to-left shunt secondary to venous collaterals, following cavopulmonary anastomosis for congenital pulmonary atresia and hypoplastic right ventricle. Conclusion Multimodality cardiac imaging using echocardiography, cardiac CT, cardiac MRI and cardiac catheterization is often required for complete characterization of complex congenital heart anomalies in adulthood. PMID:22999111

  7. Assessment of the left ventricular chamber stiffness in athletes.

    PubMed

    Popovic, Dejana; Ostojic, Miodrag C; Petrovic, Milan; Vujisic-Tesic, Bosiljka; Popovic, Bojana; Nedeljkovic, Ivana; Arandjelovic, Aleksandra; Jakovljevic, Branko; Stojanov, Vesna; Damjanovic, Svetozar

    2011-03-01

    Since diastolic dysfunction is an early sign of the heart disease, detecting diastolic disturbances is predicted to be the way for early recognizing underlying heart disease in athletes. So-called chamber stiffness index (E/e')/LVDd was predicted to be useful in distinguishing physiological from pathological left ventricular hypertrophy, because it was shown to be reduced in athletes. It remains unknown whether it is reduced in all athletic population. Standard and tissue Doppler were used to assess cardiac parameters at rest in 16 elite male wrestlers, 21 water polo player, and 20 sedentary subjects of similar age. In addition to (E/e')/LVDd index, a novel (E/e')/LVV, (E/e')/RVe'lat indices were determined. Progressive continuous maximal test on treadmill was used to assess the functional capacity. VO(2) max was the highest in water polo players, and higher in wrestlers than in controls. LVDd, LVV, LVM/BH(2.7) were higher in athletes. Left ventricular early diastolic filling velocity, deceleration and isovolumetric relaxation time did not differ. End-systolic wall stress was significantly higher in water polo players. RV e' was lower in water polo athletes. Right atrial pressure (RVE/e') was the highest in water polo athletes. (E/e'lat)/LVDd was not reduced in athletes comparing to controls (water polo players 0.83 ± 0.39, wrestlers 0.73 ± 0.29, controls 0.70 ± 0.28; P = 0.52), but (E/e's)/RVe'lat better distinguished examined groups (water polo players 0.48 ± 0.37, wrestlers 0.28 ± 0.15, controls 0.25 ± 0.16, P = 0.015) and it was the only index which predicted VO(2) max. In conclusion, intensive training does not necessarily reduce (E/e'lat)/LVDd index. A novel index (E/e's)/RVe'lat should be investigated furthermore in detecting diastolic adaptive changes. PMID:20868439

  8. Embryonic Cardiac Chamber Maturation: Trabeculation, Conduction and Cardiomyocyte Proliferation

    PubMed Central

    Samsa, Leigh Ann; Yang, Betsy; Liu, Jiandong

    2013-01-01

    Congenital heart diseases are one of the most common human birth defects. Though some congenital heart defects can be surgically corrected, treatment options for other congenital heart diseases are very limited. In many congenital heart diseases, genetic defects lead to impaired embryonic heart development or growth. One of the key development processes in cardiac development is chamber maturation, and alterations in this maturation process can manifest as a variety of congenital defects including noncompaction, systolic dysfunction, diastolic dysfunction, and arrhythmia. During development, to meet the increasing metabolic demands of the developing embryo, the myocardial wall undergoes extensive remodeling characterized by the formation of muscular luminal protrusions called cardiac trabeculae, increased cardiomyocyte mass, and development of the ventricular conduction system. Though the basic morphological and cytological changes involved in early heart development are clear, much remains unknown about the complex biomolecular mechanisms governing chamber maturation. In this review, we highlight evidence suggesting that a wide variety of basic signaling pathways and biomechanical forces are involved in cardiac wall maturation. PMID:23720419

  9. Infective Left Atrial Dissecting Flap after Cardiac Surgery

    PubMed Central

    Tabiban, Sasan; Ghaemian, Ali; Bagheri, Babak; Shokri, Mojtaba

    2014-01-01

    Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography. PMID:25309695

  10. Reptilian heart development and the molecular basis of cardiac chamber evolution

    PubMed Central

    Koshiba-Takeuchi, Kazuko; Mori, Alessandro D.; Kaynak, Bogac L.; Cebra-Thomas, Judith; Sukonnik, Tatyana; Georges, Romain O.; Latham, Stephany; Beck, Laural; Henkelman, R. Mark; Black, Brian L.; Olson, Eric N.; Wade, Juli; Takeuchi, Jun K.; Nemer, Mona; Gilbert, Scott F.; Bruneau, Benoit G.

    2009-01-01

    The emergence of terrestrial life witnessed the need for more sophisticated circulatory systems. This has evolved in birds, mammals, and crocodilians into complete septation of the heart into left and right sides, allowing separate pulmonary and systemic circulatory systems, a key requirement for the evolution of endothermy1–3. However, the evolution of the amniote heart is poorly understood. Reptilian hearts have been the subject of debate in the context of the evolution of cardiac septation: do they possess a single ventricular chamber or two incompletely septated ventricles4–7? We examined heart development in the red-eared slider turtle, Trachemys scripta elegans (a chelonian), and the green anole, Anolis carolinensis (a squamate), focusing on gene expression in the developing ventricles. Both reptiles initially form a ventricular chamber that homogenously expresses the T-box transcription factor gene Tbx5. In contrast, in birds and mammals, Tbx5 is restricted to left ventricle precursors8,9. In later stages, Tbx5 expression in the turtle (but not anole) heart is gradually restricted to a distinct left ventricle, forming a left-right gradient. This suggests that Tbx5 expression was refined during evolution to pattern the ventricles. In support of this hypothesis, we show that loss of Tbx5 in the mouse ventricle results in a single chamber lacking distinct identity, indicating a requirement for Tbx5 in septation. Importantly, misexpression of Tbx5 throughout the developing myocardium to mimic the reptilian expression pattern also results in a single mispatterned ventricular chamber lacking septation. Thus, ventricular septation is established by a steep and correctly positioned Tbx5 gradient. Our findings provide a molecular mechanism for the evolution of the amniote ventricle, and support the concept that altered expression of developmental regulators is a key mechanism of vertebrate evolution. PMID:19727199

  11. Shape and dimensions of cardiac chambers: Importance of CT section thickness and orientation. [Dogs

    Microsoft Academic Search

    E. A. Hoffman; E. L. Ritman

    1985-01-01

    Three-dimensional (3D) computed tomography (CT) scan data were used to quantitate the geometry of all heart chambers. The Dynamic Spatial Reconstructor (DSR) was used to scan dogs with in situ casts of the cardiac chambers. Chamber volumes estimated from DSR images were accurate within 5% of water displacement volume measurements of the actual casts for chambers greater than 11 ml

  12. A novel cardiac MR chamber volume model for mechanical dyssynchrony assessment

    NASA Astrophysics Data System (ADS)

    Song, Ting; Fung, Maggie; Stainsby, Jeffrey A.; Hood, Maureen N.; Ho, Vincent B.

    2009-02-01

    A novel cardiac chamber volume model is proposed for the assessment of left ventricular mechanical dyssynchrony. The tool is potentially useful for assessment of regional cardiac function and identification of mechanical dyssynchrony on MRI. Dyssynchrony results typically from a contraction delay between one or more individual left ventricular segments, which in turn leads to inefficient ventricular function and ultimately heart failure. Cardiac resynchronization therapy has emerged as an electrical treatment of choice for heart failure patients with dyssynchrony. Prior MRI techniques have relied on assessments of actual cardiac wall changes either using standard cine MR images or specialized pulse sequences. In this abstract, we detail a semi-automated method that evaluates dyssynchrony based on segmental volumetric analysis of the left ventricular (LV) chamber as illustrated on standard cine MR images. Twelve sectors each were chosen for the basal and mid-ventricular slices and 8 sectors were chosen for apical slices for a total of 32 sectors. For each slice (i.e. basal, mid and apical), a systolic dyssynchrony index (SDI) was measured. SDI, a parameter used for 3D echocardiographic analysis of dyssynchrony, was defined as the corrected standard deviation of the time at which minimal volume is reached in each sector. The SDI measurement of a healthy volunteer was 3.54%. In a patient with acute myocardial infarction, the SDI measurements 10.98%, 16.57% and 1.41% for basal, mid-ventricular and apical LV slices, respectively. Based on published 3D echocardiogram reference threshold values, the patient's SDI corresponds to moderate basal dysfunction, severe mid-ventricular dysfunction, and normal apical LV function, which were confirmed on echocardiography. The LV chamber segmental volume analysis model and SDI is feasible using standard cine MR data and may provide more reliable assessment of patients with dyssynchrony especially if the LV myocardium is thin or if the MR images have spatial resolution insufficient for proper resolution of wall thickness-features problematic for dyssynchrony assessment using existing MR techniques.

  13. Percutaneous cardioscopy of the cardiac chambers in patients with hypertrophic cardiomyopathy

    NASA Astrophysics Data System (ADS)

    Fujimori, Yoshiharu; Uchida, Yasumi; Nakamura, Fumitaka; Tomaru, Takanobu; Miwa, Atsuko; Hirose, Junichi; Sasaki, Michihiko; Oshima, Tomomitsu; Tsubouchi, Hiroyuki

    1993-05-01

    Recent advances in fiberoptic technology enables us to observe the cardiac chambers percutaneously in various categories of heart disease. We applied cardioscopy in 4 patients with HCM. Two of them presented excessive or good left ventricular function and no history of congestive heart failure (CHF). The other two patients showed reduced left ventricular function with a history of CHF. Cardioscopy was successfully performed in all patients. In patients with excessive or good left ventricular function, the color of the endocardial surface was light brown mixed with white. The trabeculae were significantly thick and contracted vigorously. In patients with reduced left ventricular function, the color was whiter, and the thickness and contraction of the trabeculae were reduced obviously. Myocardial biopsy revealed that interstitial fibrosis was prominent in the latters. These results indicate that (1) cardioscopy is safe and useful for evaluation of the internal surface of the ventricle in patients with HCM, and (2) cardioscopic characteristics of the ventricle are closely related to histopathological features.

  14. Semi-automatic algorithm for construction of the left ventricular area variation curve over a complete cardiac cycle

    PubMed Central

    2010-01-01

    Background Two-dimensional echocardiography (2D-echo) allows the evaluation of cardiac structures and their movements. A wide range of clinical diagnoses are based on the performance of the left ventricle. The evaluation of myocardial function is typically performed by manual segmentation of the ventricular cavity in a series of dynamic images. This process is laborious and operator dependent. The automatic segmentation of the left ventricle in 4-chamber long-axis images during diastole is troublesome, because of the opening of the mitral valve. Methods This work presents a method for segmentation of the left ventricle in dynamic 2D-echo 4-chamber long-axis images over the complete cardiac cycle. The proposed algorithm is based on classic image processing techniques, including time-averaging and wavelet-based denoising, edge enhancement filtering, morphological operations, homotopy modification, and watershed segmentation. The proposed method is semi-automatic, requiring a single user intervention for identification of the position of the mitral valve in the first temporal frame of the video sequence. Image segmentation is performed on a set of dynamic 2D-echo images collected from an examination covering two consecutive cardiac cycles. Results The proposed method is demonstrated and evaluated on twelve healthy volunteers. The results are quantitatively evaluated using four different metrics, in a comparison with contours manually segmented by a specialist, and with four alternative methods from the literature. The method's intra- and inter-operator variabilities are also evaluated. Conclusions The proposed method allows the automatic construction of the area variation curve of the left ventricle corresponding to a complete cardiac cycle. This may potentially be used for the identification of several clinical parameters, including the area variation fraction. This parameter could potentially be used for evaluating the global systolic function of the left ventricle. PMID:20078864

  15. Heart Rhythm and Cardiac Pacing: An Integrated Dual-Chamber Heart and Pacer Model

    Microsoft Academic Search

    Jie Lian; Dirk Müssig

    2009-01-01

    Modern cardiac pacemaker can sense electrical activity in both atrium and ventricle, and deliver precisely timed stimulations\\u000a to one or both chambers on demand. However, little is known about how the external cardiac pacing interacts with the heart’s\\u000a intrinsic activity. In this study, we present an integrated dual-chamber heart and pacer (IDHP) model to simulate atrial and\\u000a ventricular rhythms in

  16. Improvement of cardiac function by increasing stimulus strength during left ventricular pacing in cardiac resynchronization therapy.

    PubMed

    Ishibashi, Kohei; Kubo, Takashi; Kitabata, Hironori; Takarada, Shigeho; Shimamura, Kunihiro; Tanimoto, Takashi; Orii, Makoto; Shiono, Yasutsugu; Yamano, Takashi; Ino, Yasushi; Yamaguchi, Tomoyuki; Hirata, Kumiko; Tanaka, Atsushi; Imanishi, Toshio; Akasaka, Takashi

    2015-01-21

    Cardiac resynchronization therapy (CRT) is an established therapy in patients with severe heart failure due to left ventricular (LV) dyssynchrony. Increasing stimulus strength (SS) of LV pacing could capture an enlarged myocardial area and provide rapid electrical conduction. The aim of the present study was to investigate whether increasing SS of LV pacing improves LV mechanical dyssynchrony and cardiac function in patients treated with CRT.We enrolled 26 patients with CRT and changed the SS of LV pacing: 2.5 V (standard SS) and 5 V (high SS). Electrocardiography and echocardiography were performed to assess QRS duration, LV mechanical dyssynchrony, and cardiac function under each condition.The QRS duration (138.6 ± 21.4 ms versus 126.8 ± 23.1 ms, P < 0.001), septal-posterior wall motion delay (126.5 ± 42.7 ms versus 111.4 ± 55.3 ms, P = 0.012), standard deviation of time from QRS (69.6 ± 21.8 ms versus 55.6 ± 19.4 ms, P < 0.001), LV ejection fraction (29.4 ± 10.6% versus 33.4 ± 11.6%, P = 0.005), and LV stroke volume (50.7 ± 15.5 mL versus 63.8 ± 18.3 mL, P < 0.001) improved significantly in high SS compared with standard SS.Increasing SS of LV pacing in CRT improves LV mechanical dyssynchrony and cardiac function. The capture of an enlarged myocardial area by increasing SS of LV pacing might offer an acute hemodynamic benefit to patients treated with CRT. PMID:25503657

  17. Cardiac magnetic resonance T1 mapping of left atrial myocardium

    PubMed Central

    Beinart, Roy; Khurram, Irfan M.; Liu, Songtao; Yarmohammadi, Hirad; Halperin, Henry R.; Bluemke, David A.; Gai, Neville; van der Geest, Rob J.; Lima, Joao A.C.; Calkins, Hugh; Zimmerman, Stefan L.; Nazarian, Saman

    2013-01-01

    BACKGROUND Cardiac magnetic resonance (CMR) T1 mapping is an emerging tool for objective quantification of myocardial fibrosis. OBJECTIVES To (a) establish the feasibility of left atrial (LA) T1 measurements, (b) determine the range of LA T1 values in patients with atrial fibrillation (AF) vs healthy volunteers, and (c) validate T1 mapping vs LA intracardiac electrogram voltage amplitude measures. METHODS CMR imaging at 1.5 T was performed in 51 consecutive patients before AF ablation and in 16 healthy volunteers. T1 measurements were obtained from the posterior LA myocardium by using the modified Look-Locker inversion-recovery sequence. Given the established association of reduced electrogram amplitude with fibrosis, intracardiac point-by-point bipolar LA voltage measures were recorded for the validation of T1 measurements. RESULTS The median LA T1 relaxation time was shorter in patients with AF (387 [interquartile range 364–428] ms) compared to healthy volunteers (459 [interquartile range 418–532] ms; P < .001) and was shorter in patients with AF with prior ablation compared to patients without prior ablation (P = .035). In a generalized estimating equations model, adjusting for data clusters per participant, age, rhythm during CMR, prior ablation, AF type, hypertension, and diabetes, each 100-ms increase in T1 relaxation time was associated with 0.1 mV increase in intracardiac bipolar LA voltage (P = .025). CONCLUSIONS Measurement of the LA myocardium T1 relaxation time is feasible and strongly associated with invasive voltage measures. This methodology may improve the quantification of fibrotic changes in thin-walled myocardial tissues. PMID:23643513

  18. Image-guided radiotherapy for cardiac sparing in patients with left-sided breast cancer.

    PubMed

    Lemanski, Claire; Thariat, Juliette; Ampil, Federico L; Bose, Satya; Vock, Jacqueline; Davis, Rick; Chi, Alexander; Dutta, Suresh; Woods, William; Desai, Anand; Godinez, Juan; Karlsson, Ulf; Mills, Melissa; Nguyen, Nam Phong; Vinh-Hung, Vincent

    2014-01-01

    Patients with left-sided breast cancer are at risk of cardiac toxicity because of cardiac irradiation during radiotherapy with the conventional 3-dimensional conformal radiotherapy technique. In addition, many patients may receive chemotherapy prior to radiation, which may damage the myocardium and may increase the potential for late cardiac complications. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) may decrease the risk of cardiac toxicity because of the steep dose gradient limiting the volume of the heart irradiated to a high dose. Image-guided radiotherapy (IGRT) is a new technique of IMRT delivery with daily imaging, which may further reduce excessive cardiac irradiation. Preliminary results of IGRT for cardiac sparing in patients with left-sided breast cancer are promising and need to be investigated in future prospective clinical studies. PMID:25295227

  19. Image-Guided Radiotherapy for Cardiac Sparing in Patients with Left-Sided Breast Cancer

    PubMed Central

    Lemanski, Claire; Thariat, Juliette; Ampil, Federico L.; Bose, Satya; Vock, Jacqueline; Davis, Rick; Chi, Alexander; Dutta, Suresh; Woods, William; Desai, Anand; Godinez, Juan; Karlsson, Ulf; Mills, Melissa; Nguyen, Nam Phong; Vinh-Hung, Vincent

    2014-01-01

    Patients with left-sided breast cancer are at risk of cardiac toxicity because of cardiac irradiation during radiotherapy with the conventional 3-dimensional conformal radiotherapy technique. In addition, many patients may receive chemotherapy prior to radiation, which may damage the myocardium and may increase the potential for late cardiac complications. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) may decrease the risk of cardiac toxicity because of the steep dose gradient limiting the volume of the heart irradiated to a high dose. Image-guided radiotherapy (IGRT) is a new technique of IMRT delivery with daily imaging, which may further reduce excessive cardiac irradiation. Preliminary results of IGRT for cardiac sparing in patients with left-sided breast cancer are promising and need to be investigated in future prospective clinical studies. PMID:25295227

  20. Kinematic Characterization of Left Ventricular Chamber Stiffness and Relaxation

    NASA Astrophysics Data System (ADS)

    Mossahebi, Sina

    Heart failure is the most common cause of hospitalization today, and diastolic heart failure accounts for 40-50% of cases. Therefore, it is critical to identify diastolic dysfunction at a subclinical stage so that appropriate therapy can be administered before ventricular function is further, and perhaps irreversibly impaired. Basic concepts in physics such as kinematic modeling provide a unique method with which to characterize cardiovascular physiology, specifically diastolic function (DF). The advantage of an approach that is standard in physics, such as the kinematic modeling is its causal formulation that functions in contrast to correlative approaches traditionally utilized in the life sciences. Our research group has pioneered theoretical and experimental quantitative analysis of DF in humans, using both non-invasive (echocardiography, cardiac MRI) and invasive (simultaneous catheterization-echocardiography) methods. Our group developed and validated the Parametrized Diastolic Filling (PDF) formalism which is motivated by basic physiologic principles (LV is a mechanical suction pump at the mitral valve opening) that obey Newton's Laws. PDF formalism is a kinematic model of filling employing an equation of motion, the solution of which accurately predicts all E-wave contours in accordance with the rules of damped harmonic oscillatory motion. The equation's lumped parameters---ventricular stiffness, ventricular viscoelasticity/relaxation and ventricular load---are obtained by solving the 'inverse problem'. The parameters' physiologic significance and clinical utility have been repeatedly demonstrated in multiple clinical settings. In this work we apply our kinematic modeling approach to better understand how the heart works as it fills in order to advance the relationship between physiology and mathematical modeling. Through the use of this modeling, we thereby define and validate novel, causal indexes of diastolic function such as early rapid filling energy, diastatic stiffness, and relaxation and stiffness components of E-wave deceleration time.

  1. Left Ventricular Histomorphometric Findings in Dogs with Heart Failure Treated with the Acorn Cardiac Support Device

    Microsoft Academic Search

    Victor G. Sharov; Anastassia V. Todor; Hani N. Sabbah

    2005-01-01

    Progressive left ventricular (LV) dilation in the setting of heart failure is associated with increased mortality and morbidity. The Acorn Cardiac Support Device (CSD, Acorn Cardiovascular, Inc., St. Paul, MN) is a preformed polyester device that is surgically placed over the cardiac ventricles, anchored to the AV-groove and tailored anteriorly to fit snugly over the epicardial surface of the heart.

  2. Relationship between chamber mechanical properties and mean pressure-mean flow diagram of the left ventricle

    Microsoft Academic Search

    Jorge A. Negroni; Elena C. Lascano; Ricardo H. Pichelt

    1987-01-01

    We undertook a theoretical analysis of the source resistance of the left ventricle represented in a mean pressure-mean flow\\u000a $$\\\\left( {\\\\bar P - \\\\bar Q} \\\\right)$$\\u000a diagram, using the chamber properties established in terms of the pressure-volume relationship. This analysis showed that\\u000a $$\\\\bar P - \\\\bar Q$$\\u000a pairs of points should lie above the linear function proposed by Elzinga and

  3. Use of vital capacity for cardiac failure risk estimation in persons with coronary disease and left ventricular hypertrophy

    Microsoft Academic Search

    William B. Kannel; Ralph B. D'Agostino; Halit Silbershatz

    1996-01-01

    Cardiac failure is a common lethal outcome of coronary heart disease and left ventricular hypertrophy. The efficacy of forced vital capacity (FVC), measured biennially, in predicting the onset of cardiac failure was explored in 818 Framingham Study subjects with these predisposing conditions, among whom 324 developed cardiac failure. Among the men and women who had coronary disease or left ventricular

  4. Pitx2 expression defines a left cardiac lineage of cells: evidence for atrial and ventricular molecular isomerism in the iv/iv mice.

    PubMed

    Campione, M; Ros, M A; Icardo, J M; Piedra, E; Christoffels, V M; Schweickert, A; Blum, M; Franco, D; Moorman, A F

    2001-03-01

    The homeobox gene Pitx2 has been characterized as a mediator of left-right signaling in heart, gut, and lung morphogenesis. However, the relationship between the developmental role of Pitx2 and its expression pattern at the organ level has not been explored. In this study we focus on the role of Pitx2 in heart morphogenesis. Chicken Pitx2 transcripts are present in the left portion of the cardiac crescent and in the left side of the heart tube. Through looping Pitx2 is present in the left atrium, in the ventral portion of the ventricles and in the left-ventral part of the outflow tract. Mouse Pitx2 shows a similar developmental profile of expression. To test whether Pitx2 represents a lineage marker we have tagged the left portion of the chicken cardiac tube with fluorescent DiD. Labeled cells were found at HH16 in the left atrium and in the ventral region of the ventricles and the outflow tract. In the iv/iv mouse model of cardiac heterotaxia Pitx2 was abnormally expressed in the atrial and in the ventricular chambers. Furthermore, altered Pitx2 expression correlated with the occurrence of DORV. Our data reveal the existence of molecular isomerism not only in the atrial, but also in the ventricular compartment of the heart. PMID:11180966

  5. Diagnosis of cardiac amyloidosis based on the myocardial velocity profile in the hypertrophied left ventricular wall.

    PubMed

    Oki, Takashi; Tanaka, Hideji; Yamada, Hirotsugu; Tabata, Tomotsugu; Oishi, Yoshifumi; Ishimoto, Takeo; Nagase, Norio; Shinohara, Hisanori; Sakabe, Koichi; Fukuda, Nobuo

    2004-04-01

    The myocardial velocity profile (MVP), derived from color-coded tissue Doppler imaging (TDI), can identify transmural heterogeneity based on the physiology and pathology of the myocardium. This study sought to clarify whether the MVP can differentiate cardiac amyloidosis from other causes of left ventricular hypertrophy. We recorded the MVP and determined its myocardial velocity gradient (MVG) in the ventricular septum and left ventricular posterior wall using color-coded TDI in 10 patients with cardiac amyloidosis, in 25 patients with hypertensive hypertrophied left ventricular wall, in 25 patients with asymmetric septal hypertrophy of hypertrophic cardiomyopathy, and in 20 clinically normal controls. End-diastolic ventricular septal thickness was similar among the cardiac amyloidosis, hypertension, and hypertrophic cardiomyopathy groups. Percent systolic thickening of the ventricular septum and left ventricular posterior wall calculated from M-mode left ventricular echocardiograms was lower in the cardiac amyloidosis group than in the hypertension, hypertrophic cardiomyopathy, or control group. Peak MVGs during systole and early diastole were lowest in the cardiac amyloidosis group, followed, in order, by the control, hypertension, and hypertrophic cardiomyopathy groups. The systolic and early diastolic MVPs in the ventricular septum and left ventricular posterior wall showed a characteristic serrated pattern in all patients with cardiac amyloidosis, but not in any other patient groups. In conclusion, MVPs in the ventricular septum and left ventricular posterior wall show a distinctive serrated pattern that may be related to amyloid deposition in the myocardium. Myocardial tissue characterization using color-coded TDI provides diagnostic information in patients with cardiac amyloidosis. PMID:15050490

  6. Left Ventricular Aneurysm and Ventricular Tachycardia as Initial Presentation of Cardiac Sarcoidosis

    PubMed Central

    Jmeian, Ashraf; Thawabi, Mohammad; Goldfarb, Irvin; Shamoon, Fayez

    2015-01-01

    Context: Cardiac sarcoidosis (CS) is a rare, potentially fatal disease. It has a wide range of clinical presentations that range from asymptomatic electrocardiogram changes to sudden cardiac death. Ventricular aneurysms and ventricular tachycardia are seen late in the disease, and are rarely the presenting manifestation of the disease. Diagnosis of CS is challenging and often missed or delayed. Case Report: We report a 35-year-old patient who presented with sustained ventricular tachycardia and ST-elevation on electrocardiogram. Cardiac catheterization showed normal coronaries and left ventricular aneurysm. Subsequent 2D-echocardiography showed an infiltrative disease pattern. Cardiac MRI was done and showed late gadolinium enhancement in the septum, apex and lateral wall. The patient was diagnosed with cardiac sarcoidosis and treated with immune suppression and antiarrhythmic agent. In addition underwent AICD implantation. Conclusion: Our case highlights the importance of suspecting cardiac sarcoidosis in young patients presenting with electrocardiogram changes, and present an atypical presentation of this disease.

  7. Novel Left Ventricular Assist Systems® I and II for Cardiac Recovery

    PubMed Central

    Cervino, Claudio; Nasini, Victor; Sroka, Agnieszka; Diluch, Armando; Cáceres, Miguel; Sellanes, Miguel; Malusardi, Adriano; del Rio, Miguel; Pham, Si M.; Liotta, Domingo

    2005-01-01

    We have recently described the Novel Left Ventricular Assist Systems® (Novel LVAS®) I and II, which avoid cannulation of cardiac chambers and synchronize pumping with the patient's electrocardiogram. We now describe the drive system in more detail. The drive unit is an air-driven pulsatile system. The driver's parameters can be programmed. This electro-pneumatic unit contains 3 modules. A remarkable feature of the driver system is that it contains 2 pneumatic units that alternate in their function every 15 minutes. This prevents overheating and component fatigue or failure, and it enables the use of smaller units. If one of the units fails, an alarm will warn of the problem, and the other will continue indefinitely. This LVAS is synchronized with the patient's ECG, which enables it to eject the stroke volume during diastole and in this way to act as a chronic counterpulsator. We have designed the Novel LVAS to operate at a low-frequency rate. This fact, together with the electrocardiographic synchronization, offers the best prospect for myocardial recovery in patients who are also receiving ?-adrenergic blocking agents. This dual therapy will help adjust heart rate to pump frequency. PMID:16429898

  8. Novel left ventricular assist systems I and II for cardiac recovery: the driver.

    PubMed

    Cervino, Claudio; Nasini, Victor; Sroka, Agnieszka; Diluch, Armando; Cáceres, Miguel; Sellanes, Miguel; Malusardi, Adriano; del Rio, Miquel; Pham, Si M; Liotta, Domingo

    2005-01-01

    We have recently described the Novel Left Ventricular Assist Systems (Novel LVAS) I and II, which avoid cannulation of cardiac chambers and synchronize pumping with the patient's electrocardiogram. We now describe the drive system in more detail. The drive unit is an air-driven pulsatile system. The driver's parameters can be programmed. This electro-pneumatic unit contains 3 modules. A remarkable feature of the driver system is that it contains 2 pneumatic units that alternate in their function every 15 minutes. This prevents overheating and component fatigue or failure, and it enables the use of smaller units. If one of the units fails, an alarm will warn of the problem, and the other will continue indefinitely. This LVAS is synchronized with the patient's ECG, which enables it to eject the stroke volume during diastole and in this way to act as a chronic counterpulsator. We have designed the Novel LVAS to operate at a low-frequency rate. This fact, together with the electrocardiographic synchronization, offers the best prospect for myocardial recovery in patients who are also receiving beta-adrenergic blocking agents. This dual therapy will help adjust heart rate to pump frequency. PMID:16429898

  9. Ghost in the left ventricle on electrocardiogram-gated cardiac computed tomography by turbulent flow.

    PubMed

    Byun, Sung Su; Sung, Yon Mi; Lee, Kyounghoon; Kim, Yoon Kyung; Park, Jae Hyung

    2015-01-01

    We report on an extremely rare case of a fake lesion in the left ventricle on electrocardiogram-gated cardiac computed tomography simulating thrombus or tumor by turbulent flow in a 14-year-old boy. Cardiac magnetic resonance imaging with contrast-enhanced myocardial perfusion and delayed enhancement images were helpful in excluding true thrombus or tumor. Awareness of this potential pitfall is critical in order to avoid unnecessary anticoagulation or surgery. PMID:25229204

  10. Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators and left heart assist devices

    PubMed Central

    Bandorski, Dirk; Höltgen, Reinhard; Stunder, Dominik; Keuchel, Martin

    2014-01-01

    According to the recommendations of the US Food and Drug Administration and manufacturers, capsule endoscopy should not be used in patients carrying implanted cardiac devices. For this review we considered studies indexed (until 30.06.2013) in Medline [keywords: capsule endoscopy, small bowel endoscopy, cardiac pacemaker, implantable cardioverter defibrillator, interference, left heart assist device], technical information from Given Imaging and one own publication (not listed in Medline). Several in vitro and in vivo studies included patients with implanted cardiac devices who underwent capsule endoscopy. No clinically relevant interference was noticed. Initial reports on interference with a simulating device were not reproduced. Furthermore technical data of PillCam (Given Imaging) demonstrate that the maximum transmission power is below the permitted limits for cardiac devices. Hence, impairment of cardiac pacemaker, defibrillator or left ventricular heart assist device function by capsule endoscopy is not expected. However, wireless telemetry can cause dysfunction of capsule endoscopy recording. Application of capsule endoscopy is feasible and safe in patients with implanted cardiac devices such as pacemakers, cardioverter defibrillators, and left heart assist devices. Development of new technologies warrants future re-evaluation. PMID:24714370

  11. Left ventricular assist devices as a bridge to cardiac transplantation

    PubMed Central

    Holley, Christopher T.; Harvey, Laura

    2014-01-01

    Heart failure remains a significant cause of morbidity and mortality, affecting over five million patients in the United States. Continuous-flow left ventricular assist devices (LVAD) have become the standard of care for patients with end stage heart failure. This review highlights the current state of LVAD as a bridge to transplant (BTT) in patients requiring mechanical circulatory support (MCS). PMID:25132978

  12. Role of Notochord in Specification of Cardiac Left–Right Orientation in Zebrafish and Xenopus

    Microsoft Academic Search

    Maria C. Danos; H. Joseph Yost

    1996-01-01

    The left–right body axis is coordinately aligned with the orthogonal dorsoventral and anterioposterior body axes. The developmental mechanisms that regulate axis coordination are unknown. Here it is shown that the cardiac left–right orientation in zebrafish (Danio rerio) is randomized in notochord-defectiveno tailandfloating headmutants.no tail(Brachyury) andfloating head(Xnot) encode putative transcription factors that are expressed in the organizer and notochord, structures which

  13. Cardiac memory during rather than after termination of left bundle branch block.

    PubMed

    Littmann, Laszlo; Proctor, Patrick A; Givens, Priscilla M

    2014-01-01

    An 83-year-old woman with chronic left bundle branch block and remote history of pacemaker implantation for intermittent AV block was hospitalized for fatigue and leg swelling. She had no cardiac complaints. Routine 12-lead electrocardiogram showed sinus rhythm with left bundle branch block. There were diffuse negative T waves in the inferior and anterolateral leads that were concordant with the QRS complexes. Echocardiogram was normal and nuclear perfusion heart scan showed no abnormality. It was noted that the negative T waves during left bundle branch block were in the exact same leads as were the deep negative QRS complexes during ventricular pacing. The electrocardiographic changes were consistent with cardiac memory. This case is unique because cardiac memory in patients with intermittent left bundle branch block typically occurs when the QRS complexes normalize and not during left bundle branch block itself. Our findings indicate that memory Ts can develop not only after normalization of wide complex rhythms but also with alternating wide complex rhythms as in the presented case where a ventricular paced rhythm was replaced by left bundle branch block. PMID:25172185

  14. Automatic functional analysis of left ventricle in cardiac cine MRI

    PubMed Central

    Lu, Ying-Li; Connelly, Kim A.; Dick, Alexander J.; Wright, Graham A.

    2013-01-01

    Rationale and objectives A fully automated left ventricle segmentation method for the functional analysis of cine short axis (SAX) magnetic resonance (MR) images was developed, and its performance evaluated with 133 studies of subjects with diverse pathology: ischemic heart failure (n=34), non-ischemic heart failure (n=30), hypertrophy (n=32), and healthy (n=37). Materials and methods The proposed automatic method locates the left ventricle (LV), then for each image detects the contours of the endocardium, epicardium, papillary muscles and trabeculations. Manually and automatically determined contours and functional parameters were compared quantitatively. Results There was no significant difference between automatically and manually determined end systolic volume (ESV), end diastolic volume (EDV), ejection fraction (EF) and left ventricular mass (LVM) for each of the four groups (paired sample t-test, ?=0.05). The automatically determined functional parameters showed high correlations with those derived from manual contours, and the Bland-Altman analysis biases were small (1.51 mL, 1.69 mL, –0.02%, –0.66 g for ESV, EDV, EF and LVM, respectively). Conclusions The proposed technique automatically and rapidly detects endocardial, epicardial, papillary muscles’ and trabeculations’ contours providing accurate and reproducible quantitative MRI parameters, including LV mass and EF. PMID:24040616

  15. Real-time cardiac output estimation of the circulatory system under left ventricular assistance

    Microsoft Academic Search

    Makoto Yoshizawa; Hiroshi Takeda; Makoto Miura; Tomoyuki Yambe; Yoshiaki Katahira; Shin-ichi Nitta

    1993-01-01

    A method for indirect and real-time estimation of the cardiac output of the circulatory system supported by the left ventricular assist device (LVAD) is proposed. This method has low invasiveness and is useful for clinical applications of the LVAD since it needs only two measurements: the rate of blood outflow from the LVAD and the aortic pressure. The method is

  16. Turning crocodilian hearts into bird hearts: growth rates are similar for alligators with and without right-to-left cardiac shunt

    PubMed Central

    Eme, John; Gwalthney, June; Owerkowicz, Tomasz; Blank, Jason M.; Hicks, James W.

    2010-01-01

    The functional and possible adaptive significance of non-avian reptiles' dual aortic arch system and the ability of all non-avian reptiles to perform central vascular cardiac shunts have been of great interest to comparative physiologists. The unique cardiac anatomy of crocodilians – a four-chambered heart with the dual aortic arch system – allows for only right-to-left (R–L; pulmonary bypass) cardiac shunt and for surgical elimination of this shunt. Surgical removal of the R–L shunt, by occluding the left aorta (LAo) upstream and downstream of the foramen of Panizza, results in a crocodilian with an obligatory, avian/mammalian central circulation. In this study, R–L cardiac shunt was eliminated in age-matched, female American alligators (Alligator mississippiensis; 5–7 months of age). We tested the hypothesis that surgical elimination of R–L cardiac shunt would impair growth (a readily measured proxy for fitness) compared with sham-operated, age-matched controls, especially in animals subjected to exhaustive exercise. While regular exercise caused a decrease in size (snout-to-vent length, head length and body mass), elimination of the capacity for R–L cardiac shunt did not greatly reduce animal growth, despite a chronic ventricular enlargement in surgically altered juvenile alligators. We speculate that, despite being slightly smaller, alligators with an occluded LAo would have reached sexual maturity in the same breeding season as control alligators. This study suggests that crocodilian R–L cardiac shunt does not provide an adaptive advantage for juvenile alligator growth and supports the logic that cardiac shunts persist in crocodilians because they have not been selected against. PMID:20639429

  17. Cardiac Cycle Dependent Left Atrial Dynamics: Implications for Catheter Ablation of Atrial Fibrillation

    PubMed Central

    Patel, Amit R.; Fatemi, Omid; Norton, Patrick T.; West, J. Jason; Helms, Adam S.; Kramer, Christopher M.; Ferguson, John D.

    2008-01-01

    Background Left atrial volume (LAV) determines prognosis and response to therapy in atrial fibrillation. Integration of electro-anatomical maps with 3D-images rendered from CT and MRI is used to facilitate atrial fibrillation ablation. Objectives We measured LAV changes and regional motion during the cardiac cycle that might affect the accuracy of image integration and determined their relationship to standard LAV measurements. Methods MRI was performed in thirty patients with paroxysmal atrial fibrillation. Left atrial time-volume curves were generated and used to divide the left atrial function (LAEF) into pumping (PEF) and conduit (CEF) fractions and to determine the maximum LAV (LAMAX) and the pre-atrial contraction volume (PACV). LAV was measured using an MRI angiogram and traditional geometric models from echocardiography (area-length and ellipsoid). The in-plane displacement of the pulmonary veins, anterior left atrium, mitral annulus, and left atrial appendage was measured. Results LAMAX was 107±36ml and occurred at 42±5% of the RR interval. PACV was 86 ±34ml and occurred at 81±4% of the RR interval. LAEF was 45±10% and PEF was 31±10%. LAV measurements made from the MRI angiogram, area-length and ellipsoid models underestimated LAMAX by 21±25ml, 16±26ml, and 35±22ml, respectively. The anterior LA, mitral annulus, and left atrial appendage were significantly displaced during the cardiac cycle (8.8±2.0mm, 13.2±3.8mm, and 10.2±3.4mm, respectively); the pulmonary veins were not. Conclusions LAV changes significantly during the cardiac cycle and substantial regional variation in left atrial motion exists. Standard measurements of left atrial volume significantly underestimate LAMAX when compared to the gold standard measure of 3D-volumetrics. PMID:18486563

  18. Plasma nitric oxide and left ventricular function in rabbits after cardiac lymphatic obstruction

    PubMed Central

    Wang, Ying-Li; Wang, Xiao-Hua; Jin, Ye; Kong, De-Gui; Wang, Le-Xin

    2011-01-01

    This study was designed to investigate the effect of cardiac lymphatic obstruction on plasma nitric oxide (NO) and left ventricular function. The plasma NO was measured in study group (n=21) and control group rabbits (n=12) before, and 3, 7, 14, 30 and 90 days after the obstruction of cardiac lymphatic vessels. Left ventricular ejection fraction was measured with echocardiography. There was a significant reduction in the left ventricular ejection fraction following the lymphatic obstruction (0.72±0.02 vs. 0.61±0.02, p<0.01). Plasma NO in the control group remained unchanged during the observation period (54.2±4.4 vs. 52.0±4.2 ?mol/L, p>0.05). In the study group, there was a small but significant increase in the plasma NO on day 3, 7 and 14 following the lymphatic obstruction (52.3±4.1 vs. 73.4±5.9 ?mol/L, p<0.01). The plasma NO returned to the baseline levels on day 30 but reduced to 44.9±3.6 pmol/L on 90 days after the lymphatic obstruction (p<0.05). In conclusion, cardiac lymphatic obstruction was associated with a significant reduction in left ventricular function. It was also associated with an increase in the plasma NO in the first 2 weeks but there was a significant reduction in the NO levels three months after the lymphatic obstruction. PMID:21342136

  19. Physiologic analysis of cardiac cycle in an implantable impeller centrifugal left ventricular assist device.

    PubMed

    Chou, N K; Wang, S S; Chu, S H; Chen, Y S; Lin, Y H; Chang, C J; Shyu, J J; Jan, G J

    2001-08-01

    The purpose of this study was to determine the physiologic relationship between the cardiac cycle and the nonpulsatile impeller centrifugal Taita No.1 left ventricular assist device (T-LVAD) in a chronic animal study. The relationship of the cardiac cycle, pump flow, aortic pressure, left ventricle pressure, and pump power were analyzed by 5 phases in 4 stages. The isovolumetric ventricular phase is from mitral valve closure (MVC) to aortic valve opening (AVO) and is called Stage 1. The ejection phase is from AVO to aortic valve closure (AVC) and is called Stage 2. The isovolumetric relaxation phase is from AVC to MVC and is called Stage 3. The passive filling and atrial contraction phase is from MVC to mitral valve opening (MVO) and called Stage 4. Based on evidence from the physiologic volume change of the left ventricle, the change of pump flow of the T-LVAD in a cardiac cycle by variable voltages of pump control was evaluated using animal models. After left posteriolateral thoracotomy via the fifth intercostal space under general anesthesia, the nonpulsatile centrifugal T-LVAD was implanted into 2 healthy calves. The inflow of the T-LVAD was inserted into the left ventricle through the mitral valve via the left atrial appendage. The arterial blood pressure waveform was measured and recorded on the outflow of the T-LVAD. The 4 phases of a cardiac cycle were defined as MVC-AVO (Stage 1), AVO-AVC (Stage 2), AVC-MVO (Stage 3) and MVC-MVO (Stage 4) according to the outflow pressure of the outflow of the T-LVAD and differential pressure between the outflow and inflow of the T-LVAD. We carried out the real-time waveform measurement for electrocardiogram, the outflow pressure, the T-LVAD flow and the speed, as well as open loop and constant voltage (V). In a cardiac cycle, the sensing current of the T-LVAD was inverse to the speed. The flow of the T-LVAD at the 4 stages was measured individually and analyzed with different control voltages from 10 to 18 V. The highest flow ratio of MVC-AVC/AVC-MVC was noted when the T-LVAD worked on 14 V. By using analysis methodology of the flow ratio of a cardiac cycle, the optimal physiologically effective control of the T-LVAD might be achieved. PMID:11531711

  20. Fetal-Adult Cardiac Transcriptome Analysis in Rats with Contrasting Left Ventricular Mass Reveals New Candidates for Cardiac Hypertrophy

    PubMed Central

    Grabowski, Katja; Riemenschneider, Mona; Schulte, Leonard; Witten, Anika; Schulz, Angela; Stoll, Monika; Kreutz, Reinhold

    2015-01-01

    Reactivation of fetal gene expression patterns has been implicated in common cardiac diseases in adult life including left ventricular (LV) hypertrophy (LVH) in arterial hypertension. Thus, increased wall stress and neurohumoral activation are discussed to induce the return to expression of fetal genes after birth in LVH. We therefore aimed to identify novel potential candidates for LVH by analyzing fetal-adult cardiac gene expression in a genetic rat model of hypertension, i.e. the stroke-prone spontaneously hypertensive rat (SHRSP). To this end we performed genome-wide transcriptome analysis in SHRSP to identify differences in expression patterns between day 20 of fetal development (E20) and adult animals in week 14 in comparison to a normotensive rat strain with contrasting low LV mass, i.e. Fischer (F344). 15232 probes were detected as expressed in LV tissue obtained from rats at E20 and week 14 (p < 0.05) and subsequently screened for differential expression. We identified 24 genes with SHRSP specific up-regulation and 21 genes with down-regulation as compared to F344. Further bioinformatic analysis presented Efcab6 as a new candidate for LVH that showed only in the hypertensive SHRSP rat differential expression during development (logFC = 2.41, p < 0.001) and was significantly higher expressed in adult SHRSP rats compared with adult F344 (+ 76%) and adult normotensive Wistar-Kyoto rats (+ 82%). Thus, it represents an interesting new target for further functional analyses and the elucidation of mechanisms leading to LVH. Here we report a new approach to identify candidate genes for cardiac hypertrophy by combining the analysis of gene expression differences between strains with a contrasting cardiac phenotype with a comparison of fetal-adult cardiac expression patterns. PMID:25646840

  1. Abnormal left ventricular torsion and cardiac autonomic dysfunction in subjects with type 1 diabetes mellitus.

    PubMed

    Piya, Milan K; Shivu, Ganesh Nallur; Tahrani, Abd; Dubb, Kiran; Abozguia, Khalid; Phan, T T; Narendran, Parth; Pop-Busui, Rodica; Frenneaux, Michael; Stevens, Martin J

    2011-08-01

    Left ventricular torsion is increased and cardiac energetics are reduced in uncomplicated type 1 diabetes mellitus (T1DM). Our aim was to determine the relationships of these abnormalities to cardiovascular autonomic neuropathy (CAN) in subjects with T1DM. A cross-sectional study was conducted in 20 subjects with T1DM free of known coronary heart disease attending an outpatient clinic. Cardiovascular autonomic neuropathy was assessed using heart rate variability studies and the continuous wavelet transform method. Left ventricular function was determined by speckle tracking echocardiography. Magnetic resonance spectroscopy and stress magnetic resonance imaging were used to measure cardiac energetics and myocardial perfusion reserve index, respectively. Twenty subjects (age, 35 ± 8 years; diabetes duration, 16 ± 9 years; hemoglobin A(1c), 8.0% ± 1.1%) were recruited. Forty percent of the subjects exhibited definite or borderline CAN. Log peak radial strain was significantly increased in subjects with CAN compared with those without (1.56 ± 0.06 vs 1.43 ± 0.14, respectively; P = .011). Data were adjusted for log duration of diabetes, and log left ventricular torsion correlated (r = 0.593, P = .01) with log low-frequency to high-frequency ratio during the Valsalva maneuver. Log isovolumic relaxation time correlated significantly with log Valsalva ratio and log proportion of differences in consecutive RR intervals of normal beats greater than 50 milliseconds during deep breathing. However, CAN did not correlate with cardiac energetics or myocardial perfusion reserve index. Spectral analysis of low-frequency to high-frequency ratio power during the Valsalva maneuver is associated with altered left ventricular torsion in subjects with T1DM. Parasympathetic dysfunction is closely associated with diastolic deficits. Cardiovascular autonomic neuropathy is not however the principal cause of impaired cardiac energetics. The role of CAN in the development of cardiomyopathy warrants further evaluation. PMID:21306747

  2. Hemolytic staining of the endocardium of the left heart chambers: a new sign for autopsy diagnosis of freshwater drowning.

    PubMed

    Zátopková, Lenka; Hejna, Petr; Janík, Martin

    2015-03-01

    Despite the availability of modern imaging and molecular tools, traditional autopsy, and laboratory findings remain the gold standard for the diagnosis of drowning. This article presents two cases of freshwater drowning in which hemolytic staining of the endocardium of the left heart chambers was observed at autopsy. One case was a suicidal drowning of an 84-year-old man, and the other case was an accidental drowning of an 86-year-old woman. In both cases, there was marked hemolytic staining of the endocardium of the left atrium and ventricle. The endocardium of the right heart chambers was clear and transparent in appearance. Hemolytic intimal staining of the aortic root was observed in one case. Gettler's test was positive in both cases. Hemolytic discoloration of the endocardium of the left heart chambers after freshwater drowning is analogous to hemolytic staining of the aortic root. Both staining patterns result from the hypo-osmolar hemolysis that occurs in the left heart chambers and systemic circulation after hypotonic fluid passes across the alveolocapillary membrane. Hemolytic discoloration of the endocardium of the left heart chambers at autopsy may support a diagnosis of freshwater drowning. PMID:25326681

  3. Impedance cardiography: a comparison of cardiac output vs waveform analysis for assessing left ventricular systolic dysfunction.

    PubMed

    DeMarzo, Arthur P; Kelly, Russell F; Calvin, James E

    2007-01-01

    Early detection of asymptomatic left ventricular systolic dysfunction (LVSD) is beneficial in managing heart failure. Recent studies have cast doubt on the usefulness of cardiac output as an indicator of LVSD. In impedance cardiography (ICG), the dZ/dt waveform has a systolic wave called the E wave. This study looked at measurements of the amplitude and area of the E wave compared with ICG-derived cardiac output, stroke volume, cardiac index, and stroke index as methods of assessing LVSD. ICG data were obtained from patients (n=26) admitted to a coronary care unit. Clinical LVSD severity was stratified into 4 groups (none, mild, moderate, and severe) based on echocardiography data and standard clinical assessment by a cardiologist blinded to ICG data. Statistical analysis showed that the E wave amplitude and area were better indicators of the level of LVSD than cardiac output, stroke volume, cardiac index, or stroke index. ICG waveform analysis has potential as a simple point-of-care test for detecting LVSD in asymptomatic patients at high risk for developing heart failure and for monitoring LVSD in patients being treated for heart failure. PMID:17786090

  4. Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle.

    PubMed

    Miwa, Kunihisa

    2014-04-16

    The etiology of chronic fatigue syndrome (CFS) is unknown. Myalgic encephalomyelitis (ME) has been recently postulated to be the cause of CFS. Orthostatic intolerance (OI) has been known as an important symptom in predicting quality of life in CFS patients. Cardiac function may be impaired in patients with ME. The presence or absence of OI was determined both symptomatically and by using a 10-min stand-up test in 40 ME patients. Left ventricular (LV) dimensions and function were determined echocardiographically in the ME patients compared to 40 control subjects. OI was noted in 35 (97 %) of the 36 ME patients who could stand up quickly. The mean values for the cardiothoracic ratio, systemic systolic and diastolic pressures, LV end-diastolic diameter (EDD), LV end-systolic diameter, stroke volume index, cardiac index and LV mass index were all significantly smaller in the ME group than in the controls. Both a small LVEDD (<40 mm, 45 vs. 3 %) and a low cardiac index (<2 l/min/mm(2), 53 vs. 8 %) were significantly more common in the ME group than in the controls. Both heart rate and LV ejection fraction were similar between the groups. In conclusion, a small LV size with a low cardiac output was common in ME patients, in whom OI was extremely common. Cardiac dysfunction with a small heart appears to be related to the symptoms of ME. PMID:24736946

  5. Toward standardized mapping for left atrial analysis and cardiac ablation guidance

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R.; Linte, C. A.; Packer, D. L.; Robb, R. A.

    2014-03-01

    In catheter-based cardiac ablation, the pulmonary vein ostia are important landmarks for guiding the ablation procedure, and for this reason, have been the focus of many studies quantifying their size, structure, and variability. Analysis of pulmonary vein structure, however, has been limited by the lack of a standardized reference space for population based studies. Standardized maps are important tools for characterizing anatomic variability across subjects with the goal of separating normal inter-subject variability from abnormal variability associated with disease. In this work, we describe a novel technique for computing flat maps of left atrial anatomy in a standardized space. A flat map of left atrial anatomy is created by casting a single ray through the volume and systematically rotating the camera viewpoint to obtain the entire field of view. The technique is validated by assessing preservation of relative surface areas and distances between the original 3D geometry and the flat map geometry. The proposed methodology is demonstrated on 10 subjects which are subsequently combined to form a probabilistic map of anatomic location for each of the pulmonary vein ostia and the boundary of the left atrial appendage. The probabilistic map demonstrates that the location of the inferior ostia have higher variability than the superior ostia and the variability of the left atrial appendage is similar to the superior pulmonary veins. This technique could also have potential application in mapping electrophysiology data, radio-frequency ablation burns, or treatment planning in cardiac ablation therapy.

  6. Not all obstructive cardiac lesions are created equal: double-chamber right ventricle in pregnancy.

    PubMed

    Murthy, Sandhya; Lui, George; Raiszadeh, Farbod; Boxt, Lawrence; Taub, Cynthia

    2012-09-01

    Double-chambered right ventricle (DCRV) is a rare form of right ventricular outflow tract (RVOT) obstruction accounting for approximately 1% of patients with congenital heart disease. It consists of an anomalous muscle bundle that divides the right ventricle usually between the sinus (inlet) and the infundibulum (outlet). This division creates a proximal chamber with high pressure and a distal chamber with low pressure. The hemodynamic obstruction of the RVOT is usually an acquired phenomenon, however the substrate for the anomalous muscle bundle is likely congenital. The diagnosis of DCRV should be considered in the young patient with an elevated right ventricular systolic pressure and intracavitary gradient. Echocardiography and cardiac MRI are the principal diagnostic tools for the assessment of DCRV. This entity is often misdiagnosed as pulmonary hypertension in the young patient, and can often go overlooked and untreated for many years. Definitive therapy involves surgical resection of the muscle bundle. This can often be curative and if done in a timely fashion, may prevent right ventricular remodeling. We describe the unique diagnostic dilemma, the course and management of a young adult with DCRV during pregnancy. PMID:22639818

  7. Echocardiographic evidence of posteromedial hypokinesis of the left ventricle in relation to mitral regurgitation in cardiac sarcoidosis.

    PubMed

    Katsouras, Christos S; Leontaridou, Christina; Achenbach, Kirstin; Maglaras, George; Vassiliou, Miltiadis P; Kolettis, Theophilos; Goudevenos, John A; Michalis, Lampros K; Constantopoulos, Stavros H

    2006-11-01

    We describe herein the case of a 49-year-old female patient with pulmonary sarcoidosis (stage II) with cardiac manifestation. This consisted of systolic dysfunction without dilatation of the left ventricle and severe mitral insufficiency, possibly due to thinning of the posteromedial left ventricular free wall, based on our echocardiographic observations. PMID:17143715

  8. Association of HeartMate II left ventricular assist device flow estimate with thermodilution cardiac output.

    PubMed

    Hasin, Tal; Huebner, Marianne; Li, Zhuo; Brown, Daniel; Stulak, John M; Boilson, Barry A; Joyce, Lyle; Pereira, Naveen L; Kushwaha, Sudhir S; Park, Soon J

    2014-01-01

    Cardiac output (CO) assessment is important in treating patients with heart failure. Durable left ventricular assist devices (LVADs) provide essentially all CO. In currently used LVADs, estimated device flow is generated by a computerized algorithm. However, LVAD flow estimate may be inaccurate in tracking true CO. We correlated LVAD (HeartMate II) flow with thermodilution CO during postoperative care (day 2-10 after implant) in 81 patients (5,616 paired measurements). Left ventricular assist device flow and CO correlated with a low correlation coefficient (r = 0.42). Left ventricular assist device readings were lower than CO measurements by approximately 0.36 L/min, trending for larger difference with higher values. Left ventricular assist device flow measurements showed less temporal variability compared with CO. Grouping for simultaneous measured blood pressure (BP < 60, 60-70, 70-80, 80-90, and ?90), the correlation of CO with LVAD flow differed (R = 0.42, 0.67, 0.48, 0.32, 0.32, respectively). Indicating better correlation when mean blood pressure is 60 to 70 mm Hg. Left ventricular assist device flow generally trends with measured CO, but large variability exists, hence flow measures should not be assumed to equal with CO. Clinicians should take into account variables such as high CO, BP, and opening of the aortic valve when interpreting LVAD flow readout. Direct flow sensors incorporated in the LVAD system may allow for better estimation. PMID:25068779

  9. Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect

    PubMed Central

    Du, Rong-Zeng; Qian, Jun; Wu, Jun; Liang, Yi; Chen, Guang-Hua; Sun, Tao; Zhou, Ye; Zhao, Yang; Yan, Jin-Chuan

    2014-01-01

    A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly (155 m). Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46% and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk distance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient's heart functions. PMID:25593586

  10. Interatrial Conduction Time and Left Atrial Function in Patients with Left Ventricular Systolic Dysfunction: Effects of Cardiac Resynchronization Therapy

    PubMed Central

    Waggoner, Alan D.; Kalathiveetil, Sujith; Spence, Karen E.; Dávila-Román, Víctor G.; de las Fuentes, Lisa

    2009-01-01

    Background Prolonged inter-atrial conduction time (IACT) can be associated with abnormal left atrial (LA) function but has not been characterized in patients with left ventricular systolic dysfunction (LVSD) and a QRS interval >130 ms. Methods 2D-Doppler echocardiography and tissue Doppler imaging (TDI) was performed in 41 patients with LVSD (LV ejection fraction 26±5%) and 41 similarly-age normal controls (NC). 2D measurements included LV volumes, ejection fraction and LA volumes for determination of LA emptying fraction and LA ejection fraction. IACT was defined as onset of P-wave to onset of the TDI-derived late diastolic (A') velocity at the lateral mitral annulus. 2D-Doppler measurements were re-assessed in LVSD patients 4 ± 2 months after cardiac resynchronization therapy (CRT). Results IACT was longer in LVSD patients compared to NC (105±25 vs. 74±12 ms, p <.001);none of the NC had IACT> 100ms.In LVSD patients, IACT correlated modestly with measurements of LA volumes (r =.41-.48, all p <.009) but not with measurements of LA function. LVSD patients with IACT > 100 ms (n=20) prior to CRT had larger LA volumes and lower indices of LA function after CRT compared to the ? 100ms group. Significant reductions in LV end-systolic volume and increases in LV ejection fraction occurred in both groups after CRT. Conclusion TDI-derived IACT can be prolonged in patients with severe LVSD and a wide QRS interval. An IACT > 100 ms. can affect LA remodeling and function at early follow-up after CRT but does not influence the response in LV end-systolic volume or ejection fraction. PMID:19345063

  11. Effects of cardiac resynchronization therapy on left ventricular remodeling and dyssynchrony in patients with left ventricular noncompaction and heart failure.

    PubMed

    Qiu, Qiong; Chen, Yang-Xin; Mai, Jing-Ting; Yuan, Wo-Liang; Wei, Yu-Lin; Liu, Ying-Mei; Yang, Li; Wang, Jing-Feng

    2015-02-01

    Left ventricular noncompaction (LVNC) is a rare cardiomyopathy with high incidence of heart failure (HF). It is unclear whether LVNC patients with desynchronized HF would benefit from cardiac resynchronization therapy (CRT). In order to evaluate the effect of CRT on LVNC, this study explored left ventricular (LV) remodeling and mechanical synchronicity before and after CRT in LVNC patients, and compare with that in idiopathic dilated cardiomyopathy (DCM) patients. We collected 15 LVNC and 30 matched DCM patients. All the patients underwent clinical evaluation,electrocardiogram and echocardiography before CRT and ?6 months later. LV response was defined as ?15 % decrease in LV end-systolic volume (LVESV). Longitudinal synchronicity was quantified by YU-index using tissue Doppler imaging. The time delay of peak radial strain from anteroseptal to posterior wall, which derived from speckle tracking imaging, was used to quantify radial synchronicity. In LVNC group, LV ejection fraction increased from 27.6 ± 5.5 to 39.1 ± 7.0 % (P < 0.01) during follow-up, but LV volumes did not change significantly (both P > 0.05). Five LVNC patients (33.3 %) responded to CRT, and all of them were super-responders (reduction in LVESV > 30 %). In addition, the number of noncompacted segments and the thickness ratio of noncompacted to compacted myocardium decreased (both P < 0.05). Inter-ventricular, longitudinal and radial intra-ventricular dyssynchrony also reduced significantly (all P < 0.05). Compared with DCM group, there was no significant difference in LV response rate (33.3 vs. 60.0 %, P = 0.092), improvement of LV function and dyssynchrony index (all P < 0.05). In conclusion, CRT improved heart function, morphology and mechanical dyssynchrony in LVNC patients. PMID:25392055

  12. Cardiac gated ventilation

    SciTech Connect

    Hanson, C.W. III [Hospital of the Univ. of Pennsylvania, Philadelphia, PA (United States). Dept. Anesthesia; Hoffman, E.A. [Univ. of Iowa College of Medicine, Iowa City, IA (United States). Div. of Physiologic Imaging

    1995-12-31

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart.

  13. Age-dependency of cardiac and neuromuscular findings in adults with left ventricular hypertrabeculation/noncompaction.

    PubMed

    Stöllberger, Claudia; Blazek, Gerhard; Gessner, Martin; Bichler, Katharina; Wegner, Christian; Finsterer, Josef

    2015-05-01

    Left ventricular hypertrabeculation/noncompaction (LVHT) is diagnosed in all ages and is frequently associated with neuromuscular disorders (NMDs). The aim of the study was to compare patients with LVHT depending on age at diagnosis. Included were 232 patients with LVHT (72 women, mean age 52 ± 17 years) diagnosed from 1995 to 2014 at 1 echocardiographic laboratory. In 2014, their survival was assessed. Seventy-six percent of the patients were neurologically investigated, revealing specific NMDs in 18%, unspecific NMDs in 60%, and normal findings in 22%. Forty-five patients (19%) received electronic devices: implantable cardioverter-defibrillators in 26 patients, combined with cardiac resynchronization systems (n = 14) or an antibradycardic pacemaker (n = 1); antibradycardic pacemakers (n = 8); cardiac resynchronization systems (n = 4); implantable loop recorders (n = 4); life vests (n = 2); and a left ventricular assist device as a bridge to transplantation (n = 1). During 72-month follow-up, mortality was 4.9% per year. In younger age groups, more patients were referred for syncope or palpitations, whereas in older age groups, more patients were referred for heart failure. Classic cardiovascular risk factors such as hypertension and diabetes, as well as coronary artery stenosis, were rare in the young age groups but were more prevalent in older age groups. Differences between age groups were found regarding cardiac symptoms, NMDs, electrocardiographic findings, rate of device implantation, and mortality but not in location and extension of LVHT. None of the neurologically investigated patients ?70 years of age was neurologically normal. Prevalence of heart failure, electrocardiographic abnormalities, and mortality were highest in the oldest age group. In conclusion, LVHT must be considered as an echocardiographic diagnosis in all age groups. The morphologic pattern of LVHT is similar, whereas clinical manifestations and prognosis are variable among age groups. PMID:25791238

  14. Cardiac protein changes in ischaemic and dilated cardiomyopathy: a proteomic study of human left ventricular tissue

    PubMed Central

    Roselló-Lletí, Esther; Alonso, Jana; Cortés, Raquel; Almenar, Luis; Martínez-Dolz, Luis; Sánchez-Lázaro, Ignacio; Lago, Francisca; Azorín, Inmaculada; Juanatey, Jose R González; Portolés, Manuel; Rivera, Miguel

    2012-01-01

    The development of heart failure (HF) is characterized by progressive alteration of left ventricle structure and function. Previous works on proteomic analysis in cardiac tissue from patients with HF remain scant. The purpose of our study was to use a proteomic approach to investigate variations in protein expression of left ventricle tissue from patients with ischaemic (ICM) and dilated cardiomyopathy (DCM). Twenty-four explanted human hearts, 12 from patients with ICM and 12 with DCM undergoing cardiac transplantation and six non-diseased donor hearts (CNT) were analysed by 2DE. Proteins of interest were identified by mass spectrometry and validated by Western blotting and immunofluorescence. We encountered 35 differentially regulated spots in the comparison CNT versus ICM, 33 in CNT versus DCM, and 34 in ICM versus DCM. We identified glyceraldehyde 3-phophate dehydrogenase up-regulation in both ICM and DCM, and alpha-crystallin B down-regulation in both ICM and DCM. Heat shock 70 protein 1 was up-regulated only in ICM. Ten of the eleven differentially regulated proteins common to both aetiologies are interconnected as a part of a same network. In summary, we have shown by proteomics analysis that HF is associated with changes in proteins involved in the cellular stress response, respiratory chain and cardiac metabolism. Although we found altered expression of eleven proteins common to both ischaemic and dilated aetiology, we also observed different proteins altered in both groups. Furthermore, we obtained that seven of these eleven proteins are involved in cell death and apoptosis processes, and therefore in HF progression. PMID:22435364

  15. Fig. 1. On the right is the Cloud Chamber, on the left is a laptop running the Cloud Catcher software ( Alexis Kirke.)

    E-print Network

    Miranda, Eduardo Reck

    Fig. 1. On the right is the Cloud Chamber, on the left is a laptop running the Cloud Catcher software (© Alexis Kirke.) CLOUD CHAMBER: A PERFORMANCE WITH REAL TIME TWO-WAY INTERACTION BETWEEN.kirke@plymouth.ac.uk. Submitted: Abstract ,,Cloud Chamber is a live performance in which the invisible

  16. Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings

    Microsoft Academic Search

    S. Busch; T. R. C. Johnson; B. J. Wintersperger; N. Minaifar; A. Bhargava; C. Rist; M. F. Reiser; C. Becker; K. Nikolaou

    2008-01-01

    Cardiac magnetic resonance imaging and echocardiography are currently regarded as standard modalities for the quantification\\u000a of left ventricular volumes and ejection fraction. With the recent introduction of dual-source computedtomography (DSCT),\\u000a the increased temporal resolution of 83 ms should also improve the assessment of cardiac function in CT. The aim of this study\\u000a was to evaluate the accuracy of DSCT in the

  17. Evaluation of cardiac sympathetic nerve activity and left ventricular remodelling in patients with dilated cardiomyopathy on the treatment containing carvedilol

    Microsoft Academic Search

    Shu Kasama; Takuji Toyama; Takashi Hatori; Hiroyuki Sumino; Hisao Kumakura; Yoshiaki Takayama; Shuichi Ichikawa; Tadashi Suzuki; Masahiko Kurabayashi

    2007-01-01

    Aims It has been reported that carvedilol improves cardiac sympathetic nerve activity (CSNA) in patients with dilated cardiomyopathy (DCM). However, the influence of carvedilol on cardiac 123I-meta-iodoben- zylguanidine (MIBG) scintigraphic findings and left ventricular (LV) remodelling has not been determined in DCM patients. Methods and results In 30 patients with DCM and 10 normal controls, the delayed heart\\/mediastinum count (H\\/M)

  18. Surgical removal of right-to-left cardiac shunt in the American alligator (Alligator mississippiensis) causes ventricular enlargement but does not alter apnoea or metabolism during diving.

    PubMed

    Eme, John; Gwalthney, June; Blank, Jason M; Owerkowicz, Tomasz; Barron, Gildardo; Hicks, James W

    2009-11-01

    Crocodilians have complete anatomical separation between the ventricles, similar to birds and mammals, but retain the dual aortic arch system found in all non-avian reptiles. This cardiac anatomy allows surgical modification that prevents right-to-left (R-L) cardiac shunt. A R-L shunt is a bypass of the pulmonary circulation and recirculation of oxygen-poor blood back to the systemic circulation and has often been observed during the frequent apnoeic periods of non-avian reptiles, particularly during diving in aquatic species. We eliminated R-L shunt in American alligators (Alligator mississippiensis) by surgically occluding the left aorta (LAo; arising from right ventricle) upstream and downstream of the foramen of Panizza (FoP), and we tested the hypotheses that this removal of R-L shunt would cause afterload-induced cardiac remodelling and adversely affect diving performance. Occlusion of the LAo both upstream and downstream of the FoP for approximately 21 months caused a doubling of RV pressure and significant ventricular enlargement (average approximately 65%) compared with age-matched, sham-operated animals. In a separate group of recovered, surgically altered alligators allowed to dive freely in a dive chamber at 23 degrees C, occlusion of the LAo did not alter oxygen consumption or voluntary apnoeic periods relative to sham animals. While surgical removal of R-L shunt causes considerable changes in cardiac morphology similar to aortic banding in mammals, its removal does not affect the respiratory pattern or metabolism of alligators. It appears probable that the low metabolic rate of reptiles, rather than pulmonary circulatory bypass, allows for normal aerobic dives. PMID:19837897

  19. Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

    PubMed Central

    2009-01-01

    Background Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting. Materials and methods Literature review was carried out in order to identify the overall experience of an important and highly underestimated issue: the unexpected adverse outcome due to ventricular stiffness, following cardiac surgery. Results Although diverse group of patients for cardiac surgery could potentially affected from diastolic dysfunction, there are only few studies looking in to the impact of DD on the postoperative outcome; Trans-thoracic echo-cardiography (TTE) is the main stay for the diagnosis of DD. Intraoperative trans-oesophageal (TOE) adds to the management. Subgroups of DD can be defined with prognostic significance. Conclusion DD with elevated left ventricular end-diastolic pressure can predispose to increased perioperative mortality and morbidity. Furthermore, DD is often associated with systolic dysfunction, left ventricular hypertrophy or indeed pulmonary hypertension. When the diagnosis of DD is made, peri-operative attention to this group of patients becomes mandatory. PMID:19930694

  20. Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming

    PubMed Central

    Pastromas, Sokratis; Manolis, Antonis S

    2014-01-01

    Cardiac resynchronization therapy (CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class II, III and ambulatory IV, reduced left ventricular (LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes. PMID:25548617

  1. Natakalim improves post-infarction left ventricular remodeling by restoring the coordinated balance between endothelial function and cardiac hypertrophy.

    PubMed

    Zhou, Hong-Min; Zhong, Ming-Li; Zhang, Yan-Fang; Cui, Wen-Yu; Long, Chao-Liang; Wang, Hai

    2014-11-01

    Endothelial dysfunction can lead to congestive heart failure and the activation of endothelial ATP-sensitive potassium (K(ATP)) channels may contribute to endothelial protection. Therefore, the present study was carried out to investigate the hypothesis that natakalim, a novel K(ATP) channel opener, ameliorates post-infarction left ventricular remodeling and failure by correcting endothelial dysfunction. The effects of myocardial infarction were assessed 8 weeks following left anterior descending coronary artery occlusion in male Wistar rats. Depressed blood pressure, cardiac dysfunction, evidence of left ventricular remodeling and congestive heart failure were observed in the rats with myocardial infarction. Treatment with natakalim at daily oral doses of 1, 3 or 9 mg/kg/day for 8 weeks prevented these changes. Natakalim also prevented the progression to cardiac failure, which was demonstrated by the increase in right ventricular weight/body weight (RVW/BW) and relative lung weight, signs of cardiac dysfunction, as well as the overexpression of atrial and brain natriuretic peptide mRNAs. Our results also demonstrated that natakalim enhanced the downregulation of endothelium-derived nitric oxide, attenuated the upregulation of inducible nitric oxide synthase-derived nitric oxide (NO), inhibited the upregulated endothelin system and corrected the imbalance between prostacyclin and thromboxane A(2). Overall, our findings suggest that natakalim prevents post-infarction hypertrophy and cardiac failure by restoring the coordinated balance between endothelial function and cardiac hypertrophy. PMID:25215478

  2. Natakalim improves post-infarction left ventricular remodeling by restoring the coordinated balance between endothelial function and cardiac hypertrophy

    PubMed Central

    ZHOU, HONG-MIN; ZHONG, MING-LI; ZHANG, YAN-FANG; CUI, WEN-YU; LONG, CHAO-LIANG; WANG, HAI

    2014-01-01

    Endothelial dysfunction can lead to congestive heart failure and the activation of endothelial ATP-sensitive potassium (KATP) channels may contribute to endothelial protection. Therefore, the present study was carried out to investigate the hypothesis that natakalim, a novel KATP channel opener, ameliorates post-infarction left ventricular remodeling and failure by correcting endothelial dysfunction. The effects of myocardial infarction were assessed 8 weeks following left anterior descending coronary artery occlusion in male Wistar rats. Depressed blood pressure, cardiac dysfunction, evidence of left ventricular remodeling and congestive heart failure were observed in the rats with myocardial infarction. Treatment with natakalim at daily oral doses of 1, 3 or 9 mg/kg/day for 8 weeks prevented these changes. Natakalim also prevented the progression to cardiac failure, which was demonstrated by the increase in right ventricular weight/body weight (RVW/BW) and relative lung weight, signs of cardiac dysfunction, as well as the overexpression of atrial and brain natriuretic peptide mRNAs. Our results also demonstrated that natakalim enhanced the downregulation of endothelium-derived nitric oxide, attenuated the upregulation of inducible nitric oxide synthase-derived nitric oxide (NO), inhibited the upregulated endothelin system and corrected the imbalance between prostacyclin and thromboxane A2. Overall, our findings suggest that natakalim prevents post-infarction hypertrophy and cardiac failure by restoring the coordinated balance between endothelial function and cardiac hypertrophy. PMID:25215478

  3. Left Ventricular Involvement in Arrhythmogenic Right Ventricular Cardiomyopathy – A Cardiac Magnetic Resonance Imaging Study

    PubMed Central

    Ghannudi, Soraya El; Nghiem, Anthony; Germain, Philippe; Jeung, Mi-Young; Gangi, Afshin; Roy, Catherine

    2014-01-01

    BACKGROUND Few studies evaluated left ventricular (LV) involvement in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The aim of this study is to determine the frequency, clinical presentation, and pattern of LV involvement in ARVD/C (LV-ARVD/C). METHODS We retrospectively evaluated the cardiac magnetic resonance (CMR) in 202 patients referred between 2008 and 2012 to our institution, and we determined the presence or the absence of CMR criteria in the revised task force criteria 2010 for the diagnosis of ARVD/C. A total of 21 patients were diagnosed with ARVD/C according to the revised task force criteria 2010. All included patients had no previous history of myocarditis, acute coronary syndrome, or any other cardiac disease that could interfere with the interpretations of structural abnormalities. The LV involvement in ARVD/C was defined by the presence of one or more of the following criteria: LV end-diastolic volume (LVEDV; >95 mL/m2), LV ejection fraction (LVEF; <55%), LV late enhancement of gadolinium (LVLE) in a non-ischemic pattern, and LV wall motion abnormalities (WMAs). In the follow-up for the occurrence of cardiac death, ventricular tachycardia (VT) was obtained at a mean of 31 ± 20.6 months. RESULTS A total of 21 patients had ARVD/C. The median age was 48 (33–63) years. In all, 11 patients (52.4%) had LV-ARVD/C. The demographic characteristics of patients with or without LV were similar. There was a higher frequency of left bundle-branch block (LBBB) VT morphology in ARVD/C (P = 0.04). In CMR, regional WMAs of right ventricle (RV) and RV ejection fraction (RVEF; <45%) were strongly correlated with LV-WMAs (r = 0.72, P = 0.02, r = 0.75, P = 0.02, respectively). RV late enhancement of gadolinium (RVLE) was associated with LV-WMs and LVLE (r = 0.7, P = 0.03; r = 0.8, P = 0.006). LVLE was associated with LV-WMAs, LVEF, and LVEDV (r = 0.9, P = 0.001; r = 0.8, P = 0.001; r = 0.8, P = 0.01). CONCLUSION LV involvement in ARVD/C is common and frequently associated with moderate to severe right ventricular (RV) abnormalities. The impact of LV involvement in ARVD/C on the prognosis needs further investigations.

  4. Chapter 2 Background and Method Overview The cardiac left ventricle is one of the most crucial and thoroughly studied structures in the

    E-print Network

    Stetten, George

    circulation. It typically contains the great majority of cardiac muscle configured in a roughly cylindricalChapter 2 Background and Method Overview The cardiac left ventricle is one of the most crucial and follows with a general review of cardiac imaging methods comparing the abilities and limitations of RT3D

  5. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation

    Microsoft Academic Search

    Jeroen J. Bax; Thomas H. Marwick; Sander G. Molhoek; Gabe B. Bleeker; Lieselot van Erven; Eric Boersma; Paul Steendijk; Ernst E. van der Wall; Martin J. Schalij

    2003-01-01

    We evaluated patients with end-stage heart failure who have a high likelihood of response to cardiac resynchronization therapy (biventricular pacing). It appears that 20% of patients do not respond to this expensive therapy despite the use of selection criteria (dilated cardiomyopathy, heart failure, New York Heart Association class II or IV, left ventricular ejection fraction 120 ms). The presence of

  6. The Effects of Training on the Time Components of the Left Ventricle, and Cardiac Time Components: Sedentary versus Active Individuals.

    ERIC Educational Resources Information Center

    Plowman, Sharon Ann

    A review of previous research was completed to determine (a) the response of the cardiac time components of the left ventricle to varying types and intensities of training programs, (b) the probable physiological explanations for these responses, and (c) the significance of the changes which did or did not occur. It was found that, at rest,…

  7. Left ventricular flow analysis: recent advances in numerical methods and applications in cardiac ultrasound.

    PubMed

    Borazjani, Iman; Westerdale, John; McMahon, Eileen M; Rajaraman, Prathish K; Heys, Jeffrey J; Belohlavek, Marek

    2013-01-01

    The left ventricle (LV) pumps oxygenated blood from the lungs to the rest of the body through systemic circulation. The efficiency of such a pumping function is dependent on blood flow within the LV chamber. It is therefore crucial to accurately characterize LV hemodynamics. Improved understanding of LV hemodynamics is expected to provide important clinical diagnostic and prognostic information. We review the recent advances in numerical and experimental methods for characterizing LV flows and focus on analysis of intraventricular flow fields by echocardiographic particle image velocimetry (echo-PIV), due to its potential for broad and practical utility. Future research directions to advance patient-specific LV simulations include development of methods capable of resolving heart valves, higher temporal resolution, automated generation of three-dimensional (3D) geometry, and incorporating actual flow measurements into the numerical solution of the 3D cardiovascular fluid dynamics. PMID:23690874

  8. Assessment of Left Ventricular Function in Cardiac MSCT Imaging by a 4D Hierarchical Surface-Volume Matching Process

    PubMed Central

    Simon, Antoine; Boulmier, Dominique; Coatrieux, Jean-Louis; Le Breton, Hervé

    2006-01-01

    Multislice computed tomography (MSCT) scanners offer new perspectives for cardiac kinetics evaluation with 4D dynamic sequences of high contrast and spatiotemporal resolutions. A new method is proposed for cardiac motion extraction in multislice CT. Based on a 4D hierarchical surface-volume matching process, it provides the detection of the heart left cavities along the acquired sequence and the estimation of their 3D surface velocity fields. A Markov random field model is defined to find, according to topological descriptors, the best correspondences between a 3D mesh describing the left endocardium at one time and the 3D acquired volume at the following time. The global optimization of the correspondences is realized with a multiresolution process. Results obtained on simulated and real data show the capabilities to extract clinically relevant global and local motion parameters and highlight new perspectives in cardiac computed tomography imaging. PMID:23165027

  9. Cardiac Magnetic Resonance Imaging in the Diagnosis of Anterolateral Left Ventricular Ballooning, a Variant of Classic Takotsubo Cardiomyopathy

    PubMed Central

    Zbinden, R.; Mutter, M.; Weishaupt, D.

    2012-01-01

    Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks. PMID:24826260

  10. Comparison of Acute Alterations in Left Ventricular Relaxation and Diastolic Chamber Stiffness Induced by Hypoxia and Ischemia

    PubMed Central

    Serizawa, Takashi; Vogel, W. Mark; Apstein, Carl S.; Grossman, William

    1981-01-01

    To clarify conflicting reports concerning the effects of ischemia on left ventricular chamber stiffness, we compared the effects of hypoxia at constant coronary perfusion with those of global ischemia on left ventricular diastolic chamber stiffness using isolated, perfused rabbit hearts in which the left ventricle was contracting isovolumically. Since chamber volume was held constant, increases in left ventricular end diastolic pressure (LVEDP) reflected increases in chamber stiffness. At a control coronary flow rate (30 ml/min), 2 min of hypoxia and pacing tachycardia (4.0 Hz) produced major increases in postpacing LVEDP (10±1 to 24±3 mm Hg, P < 0.01) and the relaxation time constant, T, (40±4 to 224±37 ms, P < 0.001), while percent lactate extraction ratio became negative (+ 18±2 to ?48±15%, P < 0.001). Coronary perfusion pressure decreased (72±5 to 52±3 mm Hg, P < 0.01), and since coronary flow was held constant, the fall in coronary perfusion pressure reflected coronary dilation and a decrease in coronary vascular resistance. Following an average of 71±6s reoxygenation and initial heart rate (2.0 Hz), LVEDP and relaxation time constant T returned to control. Hypoxia alone (without pacing tachycardia) produced similar although less marked changes (LVEDP, 10±1 to 20±3 mm Hg; and T, 32±3 to 119±22 ms; P < 0.01 for both) and there was a strong correlation between LVEDP and T (r = 0.82, P < 0.001). When a similar degree of coronary vasodilatation was induced with adenosine, no change in LVEDP occurred, indicating that the increase in end diastolic pressure observed during hypoxia was not secondary to vascular engorgement, but due to an acute effect of hypoxia on the diastolic behavior of the ventricular myocardium. In contrast, global ischemia produced by low coronary flow (12?15 ml/min) resulted in a decrease in LVEDP, as well as a marked fall in left ventricular systolic pressure. In 14 global ischemia experiments, pacing tachycardia led to a further decline in left ventricular systolic pressure, and no increase was noted in postpacing LVEDP. Changes in lactate extraction ratio were much smaller in magnitude than with hypoxia and constant coronary perfusion. In two experiments (one at normal coronary flow and one at 15 ml/min), left ventricular systolic pressure did not change markedly from control when tachycardia was superimposed, and postpacing LVEDP showed a marked rise (to > 25 mm Hg), which gradually recovered over 1?2 min at the control heart rate. From these results, we conclude that left ventricular chamber stiffness increases when myocardial O2 demand exceeds supply. This change is usually masked in ischemic (reduced coronary flow) preparations, perhaps because of reduced turgor of the coronary vascular bed, marked reductions in systolic work (and therefore myocardial O2 requirements), and local accumulation of hydrogen ion and metabolites following acute severe reduction of coronary flow. The increased chamber stiffness during hypoxia is accompanied by marked slowing of relaxation, with increased diastolic pressure relative to volume persisting throughout diastole. PMID:7251868

  11. Optimized temporary bi-ventricular pacing improves haemodynamic function after on-pump cardiac surgery in patients with severe left ventricular systolic dysfunction: a two-centre randomized control trial

    PubMed Central

    Russell, Stuart J.; Tan, Christine; O'Keefe, Peter; Ashraf, Saeed; Zaidi, Afzal; Fraser, Alan G.; Yousef, Zaheer R.

    2012-01-01

    OBJECTIVES Optimized temporary bi-ventricular (BiV) pacing may benefit heart failure patients after on-pump cardiac surgery compared with conventional dual-chamber right ventricular (RV) pacing. An improvement in haemodynamic function with BiV pacing may reduce the duration of ‘Level 3’ intensive care. METHODS Thirty-eight patients in sinus rhythm, ejection fraction ?35%, undergoing on-pump surgical revascularization, valve surgery or both were enrolled in this study. Before closing the sternum, temporary epicardial pacing wires were attached to the right atrium, RV outflow tract and basal posterolateral wall of the left ventricle. Patients were randomly assigned to postoperative BiV pacing with the optimization of the atrio- (AV) and inter-ventricular (VV) pacing intervals (Group 1) or conventional dual-chamber right AV pacing (Group 2). The primary end-point was the duration of ‘Level 3’ intensive care. Secondary end-points included cardiac output which was measured by thermodiluation at admission to the intensive care unit and at 6 and 18 h later, in five different pacing modes. RESULTS The duration of ‘Level 3’ care was similar between groups (40 ± 35 vs 54 ± 63 h; Group 1 vs 2; P = 0.43). Cardiac output was similar in all pacing modes at baseline. At 18 h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3 l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval produced a further 4% increase in cardiac output compared with baseline settings (P = 0.005). CONCLUSIONS Postoperative haemodynamic function may be enhanced by temporary BiV pacing of high-risk patients after on-pump cardiac surgery. PMID:23138590

  12. Docosahexaenoic Acid Supplementation Alters Key Properties of Cardiac Mitochondria and Modestly Attenuates Development of Left Ventricular Dysfunction in Pressure Overload-Induced Heart Failure

    PubMed Central

    Dabkowski, Erinne R.; O’Connell, Kelly A.; Xu, Wenhong; Ribeiro, Rogerio F.; Hecker, Peter A.; Shekar, Kadambari Chandra; Stanley, William C.; Daneault, Caroline; Rosiers, Christine Des

    2015-01-01

    Purpose Supplementation with the n3 polyunsaturated fatty acid docosahexaenoic acid (DHA) is beneficial in heart failure patients, however the mechanisms are unclear. DHA is incorporated into membrane phospholipids, which may prevent mitochondrial dysfunction. Thus we assessed the effects of DHA supplementation on cardiac mitochondria and the development of heart failure caused by aortic pressure overload. Methods Pathological cardiac hypertrophy was generated in rats by thoracic aortic constriction. Animals were fed either a standard diet or were supplemented with DHA (2.3 % of energy intake). Results After 14 weeks, heart failure was evident by left ventricular hypertrophy and chamber enlargement compared to shams. Left ventricle fractional shortening was unaffected by DHA treatment in sham animals (44.1±1.6 % vs. 43.5±2.2 % for standard diet and DHA, respectively), and decreased with heart failure in both treatment groups, but to a lesser extent in DHA treated animals (34.9±1.7 %) than with the standard diet (29.7±1.5 %, P <0.03). DHA supplementation increased DHA content in mitochondrial phospholipids and decreased membrane viscosity. Myocardial mitochondrial oxidative capacity was decreased by heart failure and unaffected by DHA. DHA treatment enhanced Ca2+ uptake by subsarcolemmal mitochondria in both sham and heart failure groups. Further, DHA lessened Ca2+-induced mitochondria swelling, an index of permeability transition, in heart failure animals. Heart failure increased hydrogen peroxide-induced mitochondrial permeability transition compared to sham, which was partially attenuated in interfibrillar mitochondria by treatment with DHA. Conclusions DHA decreased mitochondrial membrane viscosity and accelerated Ca2+ uptake, and attenuated susceptibility to mitochondrial permeability transition and development of left ventricular dysfunction. PMID:24013804

  13. The Value of Myocardial Torsion and Aneurysm Volume for Evaluating Cardiac Function in Rabbit with Left Ventricular Aneurysm

    PubMed Central

    Chunmei, Wang; Xue, Yan

    2015-01-01

    Objective This study aimed to investigate the effect of left ventricular aneurysm (LVA) volume and left ventricular global torsion on cardiac function by real time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging(2D-STI), to determine the accuracy of RT-3DE and 2D-STI in assessing LV function. Methods Thirty New Zealand rabbit models of with LVA were prepared by ligation of the middle segment of the left anterior descending and left circumflex arteries. Four weeks post-procedure, RT-3DE was conducted to obtain data on LVEF, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVA volume (LVAV), Peak rotation angles at the mitral valve annulus level (MV-ROT), peak rotation angles at the apical level (AP-ROT), and left ventricular global torsion angles (LV-TOR) were measured by 2D-STI. Results Compared with controls, LVEDV and LVESV were significantly increased in the LVA group, while LVEF, MV-ROT, AP-ROT, and LV-TOR were consistently reduced (p<0.01). Moreover, LVEF correlated with LVA volume and LV torsion angle (r= -0.778 and 0.821, p<0.01). LVA volume/LVEDV had the strongest inverse relationship with LVEF (r= -0.911, p<0.01). Conclusion LVA volume, LVA volume/LVEDV, and LV torsion may be used as an indicator for evaluation of cardiac function after LVA. Moreover, LVA volume/LVEDV may be a more sensitive and reliable marker of cardiac function after LVA formation. PMID:25855970

  14. The clinical dilemma of quantifying mechanical left ventricular dyssynchrony for cardiac resynchronization therapy: segmental or global?

    PubMed

    Bajraktari, Gani; Henein, Michael Y

    2015-01-01

    Heart failure (HF) represents a serious clinical and public cause of mortality, morbidity, as well as healthcare expenditures. Guidelines for treatment of HF join in recommending multimedical regimen at targeted doses as the best medical strategy, despite that a significant percentage of patients remain symptomatic. Studies have shown that these patients might benefit from cardiac resynchronization therapy (CRT), particularly those presenting with broad QRS duration, >135 msec. Trials have already shown that CRT results in improved morbidity and survival of these patients particularly those in New York Heart Association class III-IV HF, but almost 30% do not show any symptomatic or survival benefit, hence are classified as nonresponders. Exhaustive efforts have been made in using noninvasive methods of assessing left ventricle (LV) dyssynchrony in predicting nonresponders to CRT, including Doppler echocardiography, magnetic resonance imaging, and even single photon emission computed tomography analysis, but only with modest success. In this report, we aimed to review the available evidence for assessing markers of mechanical LV dyssynchrony by various echocardiographic modalities and their respective strength in predicting favorable response to CRT treatment, comparing global with segmental ones. While the accuracy of segmental markers of dyssynchrony in predicting satisfactory response to CRT remains controversial because of various technical limitations, global markers seem easier to measure, reproducible, and potentially accurate in reflecting overall cavity response and its clinical implications. More studies are needed to qualify this proposal. PMID:25250865

  15. Fully automated assessment of left ventricular volumes and mass from cardiac magnetic resonance images.

    PubMed

    Marino, M; Veronesi, F; Corsi, C

    2014-08-01

    Quantification of left ventricular (LV) size and function from cardiac magnetic resonance (CMR) images requires manual tracing of LV borders on multiple 2D slices, which is subjective, tedious and time-consuming experience. This paper presents a fully automated method for endocardial and epicardial boundaries detection for the assessment of LV volumes, ejection fraction (EF) and mass from CMR images. The segmentation procedure is based on a combined level set approach initialized by an automatically detected point inside the LV cavity. To validate the proposed technique, myocardial boundaries were manually traced on end-diastolic (ED) and end-systolic (ES) frames by an experienced cardiologist. Bland-Altman analysis and linear regression were used to validate LV volumes, EF and mass and similarity metrics were applied to assess the agreement between manually and automatically detected contours. We found minimal biases and narrow limits of agreement for LV volumes, EF and mass; Dice coefficient, Jaccard index and Hausdorff distance evaluated for 2D ED and ES endocardial and epicardial boundaries showed adequate overlapping. The proposed technique allows fast and accurate assessment of LV volumes, EF and mass as a basis for accurate quantification of LV size and function, and myocardial scar from CMR images. PMID:25570149

  16. 4-D Cardiac MR Image Analysis: Left and Right Ventricular Morphology and Function

    PubMed Central

    Wahle, Andreas; Johnson, Ryan K.; Scholz, Thomas D.; Sonka, Milan

    2010-01-01

    In this study, a combination of active shape model (ASM) and active appearance model (AAM) was used to segment the left and right ventricles of normal and Tetralogy of Fallot (TOF) hearts on 4-D (3-D+time) MR images. For each ventricle, a 4-D model was first used to achieve robust preliminary segmentation on all cardiac phases simultaneously and a 3-D model was then applied to each phase to improve local accuracy while maintaining the overall robustness of the 4-D segmentation. On 25 normal and 25 TOF hearts, in comparison to the expert traced independent standard, our comprehensive performance assessment showed subvoxel segmentation accuracy, high overlap ratios, good ventricular volume correlations, and small percent volume differences. Following 4-D segmentation, novel quantitative shape and motion features were extracted using shape information, volume-time and dV/dt curves, analyzed and used for disease status classification. Automated discrimination between normal/TOF subjects achieved 90%–100% sensitivity and specificity. The features obtained from TOF hearts show higher variability compared to normal subjects, suggesting their potential use as disease progression indicators. The abnormal shape and motion variations of the TOF hearts were accurately captured by both the segmentation and feature characterization. PMID:19709962

  17. MDCT Venography Evaluation of a Rare Collateral Vein Draining from the Left Subclavian Vein to the Great Cardiac Vein

    PubMed Central

    Abchee, Antoine; Saade, Charbel; Al-Mohiy, Hussain; El-Merhi, Fadi

    2014-01-01

    Congenital vascular anomalies of the venous drainage in the chest affect both cardiac and non-cardiac structures. Collateral venous drainage from the left subclavian vein to the great cardiac vein is a rare venous drainage pattern. These anomalies present a diagnostic challenge. Multi-detector computed tomography (MDCT) is useful in the diagnosis and treatment planning of these clinically complex disorders. We present a case report of an 18-year-old Caucasian male who came to our institute for evaluation of venous drainage patterns to the heart. We describe the contrast technique of bilateral dual injection MDCT venography and the imaging features of the venous drainage patterns to the heart. PMID:25379351

  18. Rupture of a giant cardiac hydatid cyst in the left ventricular free wall: successful surgical management of a rare entity.

    PubMed

    Hosseinian, Adallat; Mohammadzadeh, Alireza; Shahmohammadi, Ghader; Hasanpour, Mohammad; Maleki, Nasrollah; Doustkami, Hossein; Haghdoost, Zarafshan

    2013-01-01

    Hydatid cyst of heart is a rare but potentially fatal site of pathology, especially left ventricular free wall. We managed a successful surgical treatment on a case of a 24 year old man who had a giant cardiac hydatid cyst (71 x 64 mm) that ruptured left ventricular free wall. The cyst was excised gently and all the cystic materials were removed, the cyst cavity was closed with GORE-TEX soft tissue patch. The patient was discharged on the 9th postoperative day without symptoms. This case is different from other cardiac hydatid cysts that have been reported in literature previously; because this patient was young and had advanced phase of the disease that presented to our clinic lately. Additionally, the cyst had limited both ventricular volumes significantly. PMID:23785588

  19. Association Between Tangential Beam Treatment Parameters and Cardiac Abnormalities After Definitive Radiation Treatment for Left-Sided Breast Cancer

    SciTech Connect

    Correa, Candace R. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Das, Indra J. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)], E-mail: Das@xrt.upenn.edu; Litt, Harold I. [Department of Radiology-Cardiovascular Imaging Section, University of Pennsylvania, Philadelphia, PA (United States); Ferrari, Victor [Department of Medicine-Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA (United States); Hwang, W.-T. [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA (United States); Solin, Lawrence J.; Harris, Eleanor E. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

    2008-10-01

    Purpose: To examine the association between radiation treatment (RT) parameters, cardiac diagnostic test abnormalities, and clinical cardiovascular diagnoses among patients with left-sided breast cancer after breast conservation treatment with tangential beam RT. Methods and Materials: The medical records of 416 patients treated between 1977 and 1995 with RT for primary left-sided breast cancer were reviewed for myocardial perfusion imaging and echocardiograms. Sixty-two patients (62/416, 15%) underwent these cardiac diagnostic tests for cardiovascular symptoms and were selected for further study. Central lung distance and maximum heart width and length in the treatment field were determined for each patient. Medical records were reviewed for cardiovascular diagnoses and evaluation of cardiac risk factors. Results: At a median of 12 years post-RT the incidence of cardiac diagnostic test abnormalities among symptomatic left-sided irradiated women was significantly higher than the predicted incidence of cardiovascular disease in the patient population, 6/62 (9%) predicted vs. 24/62 (39%) observed, p 0.001. As compared with patients with normal tests, patients with cardiac diagnostic test abnormalities had a larger median central lung distance (2.6 cm vs. 2.2 cm, p = 0.01). Similarly, patients with vs. without congestive heart failure had a larger median central lung distance (2.8 cm vs. 2.3 cm, p = 0.008). Conclusions: Contemporary RT for early breast cancer may be associated with a small, but potentially avoidable, risk of cardiovascular morbidity that is associated with treatment technique.

  20. Cardiac troponin T as an indicator of reduced left ventricular contractility in experimental anthracycline-induced cardiomyopathy

    Microsoft Academic Search

    Ivona Klimtova; Michaela Adamcova; Vladimir Gersl; Radomir Hrdina; Martin Sterba; Jana Kaplanova ´ Æ

    Purpose: Cardiac troponin T (cTnT) plasma concentration is considered a useful marker of anthra- cycline-induced cardiomyopathy. In this study we used daunorubicin-treated Chinchilla rabbits as a model to investigate the relationship between left ventricular contractility and cTnT plasma concentrations. Meth- ods: Two groups of animals were used: a control group (n=8) received i.v. saline, and an experimental group (n=11) received

  1. Cardiac troponin T as an indicator of reduced left ventricular contractility in experimental anthracycline-induced cardiomyopathy

    Microsoft Academic Search

    Tomáš Šim?nek; Ivona Klimtová; Michaela Adamcová; Vladimír Geršl; Radomír Hrdina; Martin Št?rba; Jana Kaplanová; Yvona Mazurová

    2003-01-01

    PurposeCardiac troponin T (cTnT) plasma concentration is considered a useful marker of anthracycline-induced cardiomyopathy. In this study we used daunorubicin-treated Chinchilla rabbits as a model to investigate the relationship between left ventricular contractility and cTnT plasma concentrations.MethodsTwo groups of animals were used: a control group ( n=8) received i.v. saline, and an experimental group ( n=11) received daunorubicin (3 mg\\/kg, i.v.).

  2. Relationship between postprandial changes in cardiac left ventricular function, glucose and insulin concentrations, gastric emptying, and satiety in healthy subjects

    Microsoft Academic Search

    Joanna Hlebowicz; Sandra Lindstedt; Ola Björgell; Magnus Dencker

    2011-01-01

    Background  The digestion of food is known to alter the hemodynamics of the body significantly. The purpose of this study was to study\\u000a the postprandial changes in stroke volume (SV), cardiac output (CO) and left ventricular (LV) longitudinal systolic and diastolic\\u000a functions measured with tissue Doppler imaging, in relation to gastric emptying rate (GER), satiety, and glucose and insulin\\u000a concentrations in

  3. Association of Cardiac Troponin T With Left Ventricular Structure and Function in CKD

    PubMed Central

    Mishra, Rakesh K.; Li, Yongmei; DeFilippi, Christopher; Fischer, Michael J.; Yang, Wei; Keane, Martin; Chen, Jing; He, Jiang; Kallem, Radhakrishna; Horwitz, Ed; Rafey, Mohammad; Raj, Dominic S.; Go, Alan S.; Shlipak, Michael G.

    2013-01-01

    Background Serum cardiac troponin T (cTnT) is associated with increased risk of heart failure and cardiovascular death in several population settings. We evaluated associations of cTnT with cardiac structural and functional abnormalities in a cohort of chronic kidney disease (CKD) patients without heart failure. Study Design Cross-sectional. Setting & Participants Chronic Renal Insufficiency Cohort (CRIC; N= 3,243) Predictor The primary predictor was cTnT. Secondary predictors included demographic and clinical characteristics, hemoglobin level, high-sensitivity C-reactive protein, and estimated glomerular filtration rate using cystatin C. Outcomes Echocardiography was used to determine left ventricular (LV) mass and LV systolic and diastolic function. Measurements Circulating cTnT was measured in stored sera using the highly sensitive assay. Logistic and linear regression models were used to examine associations of cTnT with each echocardiographic outcome. Results cTnT was detectable in 2,735 (84%) persons; the median was 13.3 (IQR, 7.7–23.8) pg/mL. Compared with undetectable cTnT (<3.0 pg/mL), the highest quartile (23.9 – 738.7 pg/mL) was associated with approximately two times as likely to experience LV hypertrophy (OR, 2.43; 95% CI, 1.44–4.09) in the fully adjusted model. cTnT had a more modest association with LV systolic dysfunction; as a log-linear variable, a significant association was present in the fully adjusted model (OR of 1.4 [95% CI, 1.1–1.7] per 1-log unit; p<0.01). There was no significant independent association between cTnT and LV diastolic dysfunction. When evaluated as a screening test, cTnT functioned only modestly for LV hypertrophy and concentric hypertrophy detection (area under the curve, 0.64 for both) with weaker areas under the curve for the other outcomes. Limitations The presence of coronary artery disease was not formally assessed using either noninvasive or angiographic techniques in this study. Conclusions In this large CKD cohort without heart failure, detectable cTnT had a strong association with LV hypertrophy, a more modest association with LV systolic dysfunction, and no association with diastolic dysfunction. These findings indicate that circulating cTnT levels in CKD are predominantly an indicator of pathological LV hypertrophy. PMID:23291148

  4. Targeted inactivation of Cerberus like-2 leads to left ventricular cardiac hyperplasia and systolic dysfunction in the mouse.

    PubMed

    Araújo, Ana Carolina; Marques, Sara; Belo, José António

    2014-01-01

    Previous analysis of the Cerberus like 2 knockout (Cerl2-/-) mouse revealed a significant mortality during the first day after birth, mostly due to cardiac defects apparently associated with randomization of the left-right axis. We have however, identified Cerl2-associated cardiac defects, particularly a large increase in the left ventricular myocardial wall in neonates that cannot be explained by laterality abnormalities. Therefore, in order to access the endogenous role of Cerl2 in cardiogenesis, we analyzed the embryonic and neonatal hearts of Cerl2 null mutants that did not display a laterality phenotype. Neonatal mutants obtained from the compound mouse line Cer2-/-::Mlc1v-nLacZ24+, in which the pulmonary ventricle is genetically marked, revealed a massive enlargement of the ventricular myocardium in animals without laterality defects. Echocardiography analysis in Cerl2-/- neonates showed a left ventricular systolic dysfunction that is incompatible with a long lifespan. We uncovered that the increased ventricular muscle observed in Cerl2-/- mice is caused by a high cardiomyocyte mitotic index in the compact myocardium which is mainly associated with increased Ccnd1 expression levels in the left ventricle at embryonic day (E) 13. Interestingly, at this stage we found augmented left ventricular expression of Cerl2 levels when compared with the right ventricle, which may elucidate the regionalized contribution of Cerl2 to the left ventricular muscle formation. Importantly, we observed an increase of phosphorylated Smad2 (pSmad2) levels in embryonic (E13) and neonatal hearts indicating a prolonged TGF?s/Nodal-signaling activation. Concomitantly, we detected an increase of Baf60c levels, but only in Cerl2-/- embryonic hearts. These results indicate that independently of its well-known role in left-right axis establishment Cerl2 plays an important role during heart development in the mouse, mediating Baf60c levels by exerting an important control of the TGF?s/Nodal-signaling pathway. PMID:25033293

  5. Targeted Inactivation of Cerberus Like-2 Leads to Left Ventricular Cardiac Hyperplasia and Systolic Dysfunction in the Mouse

    PubMed Central

    Araújo, Ana Carolina; Marques, Sara; Belo, José António

    2014-01-01

    Previous analysis of the Cerberus like 2 knockout (Cerl2?/?) mouse revealed a significant mortality during the first day after birth, mostly due to cardiac defects apparently associated with randomization of the left-right axis. We have however, identified Cerl2-associated cardiac defects, particularly a large increase in the left ventricular myocardial wall in neonates that cannot be explained by laterality abnormalities. Therefore, in order to access the endogenous role of Cerl2 in cardiogenesis, we analyzed the embryonic and neonatal hearts of Cerl2 null mutants that did not display a laterality phenotype. Neonatal mutants obtained from the compound mouse line Cer2?/?::Mlc1v-nLacZ24+, in which the pulmonary ventricle is genetically marked, revealed a massive enlargement of the ventricular myocardium in animals without laterality defects. Echocardiography analysis in Cerl2?/? neonates showed a left ventricular systolic dysfunction that is incompatible with a long lifespan. We uncovered that the increased ventricular muscle observed in Cerl2?/? mice is caused by a high cardiomyocyte mitotic index in the compact myocardium which is mainly associated with increased Ccnd1 expression levels in the left ventricle at embryonic day (E) 13. Interestingly, at this stage we found augmented left ventricular expression of Cerl2 levels when compared with the right ventricle, which may elucidate the regionalized contribution of Cerl2 to the left ventricular muscle formation. Importantly, we observed an increase of phosphorylated Smad2 (pSmad2) levels in embryonic (E13) and neonatal hearts indicating a prolonged TGF?s/Nodal-signaling activation. Concomitantly, we detected an increase of Baf60c levels, but only in Cerl2?/? embryonic hearts. These results indicate that independently of its well-known role in left-right axis establishment Cerl2 plays an important role during heart development in the mouse, mediating Baf60c levels by exerting an important control of the TGF?s/Nodal-signaling pathway. PMID:25033293

  6. Cardiac Magnetic Resonance Assessment of Left Ventricular Mass in Autosomal Dominant Polycystic Kidney Disease

    PubMed Central

    Abebe, Kaleab Z.; Schrier, Robert W.; Chapman, Arlene B.; Torres, Vicente E.; Bost, James; Kaya, Diana; Miskulin, Dana C.; Steinman, Theodore I.; Braun, William; Winklhofer, Franz T.; Hogan, Marie C.; Rahbari-Oskoui, Frederic; Kelleher, Cass; Masoumi, Amirali; Glockner, James; Halin, Neil J.; Martin, Diego; Remer, Erick; Patel, Nayana; Pedrosa, Ivan; Wetzel, Louis H.; Thompson, Paul A.; Miller, J. Philip; Meyers, Catherine M.; Bae, K. Ty

    2011-01-01

    Summary Background and objectives Autosomal dominant polycystic kidney disease (ADPKD) is associated with a substantial cardiovascular disease burden including early onset hypertension, intracranial aneurysms, and left ventricular hypertrophy (LVH). A 41% prevalence of LVH has been reported in ADPKD, using echocardiographic assessment of LV mass (LVM). The HALT PKD study was designed to assess the effect of intensive angiotensin blockade on progression of total kidney volume and LVM. Measurements of LVM were performed using cardiac magnetic resonance (MR). Design, setting, participants, & measurements Five hundred forty-three hypertensive patients with GFR >60 ml/min per 1.73 m2 underwent MR assessment of LVM at baseline. LVM was adjusted for body surface area and expressed as LVM index (LVMI; g/m2). Results Baseline BP was 125.1 ± 14.5/79.3 ± 11.6 mmHg. Average duration of hypertension was 5.79 years. Prior use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was present in 59.5% of patients. The prevalence of LVH assessed using nonindexed LVM (g) was 3.9% (n = 21, eight men and 13 women) and 0.93% (n = 5, one man and four women) using LVMI (g/m2). In exploratory analyses, the prevalence of LVH using LVM indexed to H2.7, and the allometric index ppLVmassHW, ranged from 0.74% to 2.23% (n = 4 to 12). Multivariate regression showed significant direct associations of LVMI with systolic BP, serum creatinine, and albuminuria; significant inverse associations with LVMI were found with age and female gender. Conclusions The prevalence of LVH in hypertensive ADPKD patients <50 years of age with short duration of hypertension, and prior use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is low. Early BP intervention in ADPKD may have decreased LVH and may potentially decrease cardiovascular mortality. PMID:21903983

  7. Left ventricular modelling: a quantitative functional assessment tool based on cardiac magnetic resonance imaging

    PubMed Central

    Conti, C. A.; Votta, E.; Corsi, C.; De Marchi, D.; Tarroni, G.; Stevanella, M.; Lombardi, M.; Parodi, O.; Caiani, E. G.; Redaelli, A.

    2011-01-01

    We present the development and testing of a semi-automated tool to support the diagnosis of left ventricle (LV) dysfunctions from cardiac magnetic resonance (CMR). CMR short-axis images of the LVs were obtained in 15 patients and processed to detect endocardial and epicardial contours and compute volume, mass and regional wall motion (WM). Results were compared with those obtained from manual tracing by an expert cardiologist. Nearest neighbour tracking and finite-element theory were merged to calculate local myocardial strains and torsion. The method was tested on a virtual phantom, on a healthy LV and on two ischaemic LVs with different severity of the pathology. Automated analysis of CMR data was feasible in 13/15 patients: computed LV volumes and wall mass correlated well with manually extracted data. The detection of regional WM abnormalities showed good sensitivity (77.8%), specificity (85.1%) and accuracy (82%). On the virtual phantom, computed local strains differed by less than 14 per cent from the results of commercial finite-element solver. Strain calculation on the healthy LV showed uniform and synchronized circumferential strains, with peak shortening of about 20 per cent at end systole, progressively higher systolic wall thickening going from base to apex, and a 10° torsion. In the two pathological LVs, synchronicity and homogeneity were partially lost, anomalies being more evident for the more severely injured LV. Moreover, LV torsion was dramatically reduced. Preliminary testing confirmed the validity of our approach, which allowed for the fast analysis of LV function, even though future improvements are possible. PMID:22670208

  8. Chamber-Specific Cardiac Expression of Tbx5 and Heart Defects in HoltOram Syndrome

    E-print Network

    Tabin, Cliff

    basis for the prevalence of atrial septal defects (ostium primum and secundum), ventricular muscular pattern of asymmetric (left predominant) upper limb malformations and atrial or ventricular septal defects septal defects, and left-sided malformations (endocardial cushion defects, hypoplastic left heart

  9. Echocardiographic assessment of left ventricular function in thyrotoxicosis and implications for the therapeutics of thyrotoxic cardiac disease

    PubMed Central

    Anakwue, Raphael C; Onwubere, Basden J; Ikeh, Vincent; Anisiuba, Benedict; Ike, Samuel; Anakwue, Angel-Mary C

    2015-01-01

    Introduction Thyrotoxicosis is an endocrine disorder with prominent cardiovascular manifestations. Thyroid hormone acts through genomic and non-genomic mechanisms to regulate cardiac function. Echocardiography is a useful, non-invasive, easily accessible, and affordable tool for studying the structural and physiological function of the heart. Aim We studied thyrotoxicosis patients in a Nigerian Teaching Hospital and employed trans-thoracic echocardiography to find out if there were abnormalities in the hearts of these patients. Methods Fifty adult thyrotoxicosis patients diagnosed with clinical and thyroid function tests in the medical out-patient unit of the hospital were recruited and we performed transthoracic echocardiography with a Sonos 2000 HP machine. Results We documented the presence of abnormalities in the following proportion of thyrotoxicosis patients: left ventricular enhanced systolic function in 30%, enhanced diastolic function in 34%, diastolic dysfunction in 34%, heart failure with preserved ejection fraction in10%, heart failure with reduced ejection fraction in 6%, and left ventricular hypertrophy in 34%. Conclusion Echocardiography was useful in the stratification of cardiac function abnormalities and is indispensable as a guide in the choice of therapeutic options in patients with thyrocardiac disease. The finding of left ventricular enhanced systolic and diastolic functions signify early echocardiographic detectable cardiac abnormalities in thyrotoxicosis, and the clinical management includes the use of anti-thyroid drugs and ?-adrenoceptor blockade. Diastolic dysfunction in thyrotoxicosis patients asymptomatic for cardiac disease should be treated with anti-thyroid drugs, and ?-adrenoceptor blockade. The judicious application of clinical therapeutics will guide the use of anti-thyroid drugs, diuretics, digoxin, angiotensin inhibitors, and ?-adrenoceptor blockade in the successful management of thyrotoxicosis patients with heart failure and reduced, preserved, or increased ejection fraction: parameters which are derived from echocardiography. PMID:25709461

  10. Hybrid segmentation of left ventricle in cardiac MRI using Gaussian-mixture model and region restricted dynamic programming.

    PubMed

    Hu, Huaifei; Liu, Haihua; Gao, Zhiyong; Huang, Lu

    2013-05-01

    Segmentation of the left ventricle from cardiac magnetic resonance images (MRI) is very important to quantitatively analyze global and regional cardiac function. The aim of this study is to develop a novel and robust algorithm which can improve the accuracy of automatic left ventricle segmentation on short-axis cardiac MRI. The database used in this study consists of three data sets obtained from the Sunnybrook Health Sciences Centre. Each data set contains 15 cases (4 ischemic heart failures, 4 non-ischemic heart failures, 4 left ventricle (LV) hypertrophies and 3 normal cases). Three key techniques are developed in this segmentation algorithm: (1) ray scanning approach is designed for segmentation of images with left ventricular outflow tract (LVOT), (2) a region restricted technique is employed for epicardial contour extraction, and (3) an edge map with non-maxima gradient suppression approach is put forward to improve the dynamic programming to derive the epicardial boundary. The validation experiments were performed on a pool of data sets of 45 cases. For both endo- and epi-cardial contours of our results, percentage of good contours is about 91%, the average perpendicular distance is about 2mm. The overlapping dice metric is about 0.92. The regression and determination coefficient between the experts and our proposed method on the ejection fraction (EF) is 1.01 and 0.9375, respectively; they are 0.9 and 0.8245 for LV mass. The proposed segmentation method shows the better performance and is very promising in improving the accuracy of computer-aided diagnosis systems in cardiovascular diseases. PMID:23245907

  11. The Impacts of Cardiac Rehabilitation Program on Echocardiographic Parameters in Coronary Artery Disease Patients with Left Ventricular Dysfunction

    PubMed Central

    Sadeghi, Masoumeh; Garakyaraghi, Mohammad; Khosravi, Mohsen; Taghavi, Mahboobeh; Sarrafzadegan, Nizal; Roohafza, Hamidreza

    2013-01-01

    Introduction. The accurate impact of exercise on coronary artery disease (CAD) patients with left ventricular dysfunction is still debatable. We studied the effects of cardiac rehabilitation (CR) on echocardiography parameters in CAD patients with ventricular dysfunction. Methods. Patients with CAD who had ventricular dysfunction were included into an exercise-based rehabilitation program and received rehabilitation for eight weeks. All subjects underwent echocardiography before and at the end of the rehabilitation program. The echocardiography parameters, including left ventricular ejection fraction (LVEF), LV end-diastolic (LVEDD) and end-systolic diameters (LVESD), and peak exercise capacity measured in metabolic equivalents (METs), were assessed. Results. Seventy patients (mean age = 57.5 ± 10.2 years, 77.1% males) were included into the study. At the end of rehabilitation period, the LVEF increased from 45.14 ± 5.77% to 50.44 ± 8.70% (P < 0.001), and the peak exercise capacity increased from 8.00 ± 2.56 to 10.08 ± 3.00 METs (P < 0.001). There was no significant change in LVEDD (54.63 ± 12.96 to 53.86 ± 8.95 mm, P = 0.529) or in LVESD (38.91 ± 10.83 to 38.09 ± 9.04 mm, P = 0.378) after rehabilitation. Conclusion. Exercise training in postmyocardial infarction patients with ventricular dysfunction could have beneficial effects on cardiac function without adversely affecting LV remodeling or causing serious cardiac complications. PMID:24459599

  12. Deterioration of left ventricular chamber performance after bed rest : "cardiovascular deconditioning" or hypovolemia?

    NASA Technical Reports Server (NTRS)

    Perhonen, M. A.; Zuckerman, J. H.; Levine, B. D.; Blomqvist, C. G. (Principal Investigator)

    2001-01-01

    BACKGROUND: Orthostatic intolerance after bed rest is characterized by hypovolemia and an excessive reduction in stroke volume (SV) in the upright position. We studied whether the reduction in SV is due to a specific adaptation of the heart to head-down tilt bed rest (HDTBR) or acute hypovolemia alone. METHODS AND RESULTS: We constructed left ventricular (LV) pressure-volume curves from pulmonary capillary wedge pressure and LV end-diastolic volume and Starling curves from pulmonary capillary wedge pressure and SV during lower body negative pressure and saline loading in 7 men (25+/-2 years) before and after 2 weeks of -6 degrees HDTBR and after the acute administration of intravenous furosemide. Both HDTBR and hypovolemia led to a similar reduction in plasma volume. However, baseline LV end-diastolic volume decreased by 20+/-4% after HDTBR and by 7+/-2% after hypovolemia (interaction P<0.001). Moreover, SV was reduced more and the Starling curve was steeper during orthostatic stress after HDTBR than after hypovolemia. The pressure-volume curve showed a leftward shift and the equilibrium volume of the left ventricle was decreased after HDTBR; however, after hypovolemia alone, the curve was identical, with no change in equilibrium volume. Lower body negative pressure tolerance was reduced after both conditions; it decreased by 27+/-7% (P<0.05) after HDTBR and by 18+/-8% (P<0.05) after hypovolemia. CONCLUSIONS: Chronic HDTBR leads to ventricular remodeling, which is not seen with equivalent degrees of acute hypovolemia. This remodeling leads to a greater decrease in SV during orthostatic stress after bed rest than hypovolemia alone, potentially contributing to orthostatic intolerance.

  13. Left ventricular systolic asynchrony: an important sign for cardiac involvement in plaque-type psoriasis.

    PubMed

    Örem, Cihan; Kazaz, Zeynep; Yayl?, Sava?; Çevik, Osman Ça?lar; K?r??, Abdulkadir; Öztürk, Mustafa; Arslan, Bilgihan; Örem, As?m

    2014-03-01

    Psoriasis is associated with cardiovascular diseases (CVD). The purpose of this study was to evaluate the relationship between Left Ventricular (LV) asynchrony and psoriasis. Asynchrony was assessed in 31 patients with psoriasis without evidence of CVD and 25 healthy subjects. All the patients and controls were subjected to tissue synchronization imaging (TSI), and conventional and tissue Doppler echocardiography. The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-midsegmental model was measured on ejection phase TSI images, and four TSI parameters of systolic asynchrony were computed. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels in psoriatic patients were measured. All TSI parameters of LV asynchrony increased in psoriatic patients compared to the controls: the standard deviation (SD) of the 12 LV segments Ts (37.3 ± 14.8 vs. 24.6 ± 11.1, P = 0.002); the maximal difference in Ts between any two of the 12 LV segments (112.7 ± 39.8 vs. 83.1 ± 38.1, P = 0.01), the SD of the six basal LV segments (36.2 ± 17.3 vs. 23.2 ± 14.5, P = 0.008); and the maximal difference in Ts between any two of the six basal LV segments (91.3 ± 43.5 vs. 60.5 ± 37.3, P = 0.01). LV asynchrony was observed in 67.7% of psoriatic patients. Higher CRP (1.9 ± 1.3 vs. 0.92 ± 1.4, P = 0.04) and ESR (34.8 ± 17.3 vs. 20 ± 15.3, P = 0.03) levels were determined in patients with LV asynchrony. Regression analysis showed LV systolic asynchrony (P = 0.02), Tei index (P = 0.03), EF (P = 0.04), and E/A ratio (P = 0.04) were independently associated with psoriasis. LV asynchrony firstly described in patients with psoriasis may be an important finding of cardiac involvement in psoriasis. PMID:24320841

  14. Joint multi-object registration and segmentation of left and right cardiac ventricles in 4D cine MRI

    NASA Astrophysics Data System (ADS)

    Ehrhardt, Jan; Kepp, Timo; Schmidt-Richberg, Alexander; Handels, Heinz

    2014-03-01

    The diagnosis of cardiac function based on cine MRI requires the segmentation of cardiac structures in the images, but the problem of automatic cardiac segmentation is still open, due to the imaging characteristics of cardiac MR images and the anatomical variability of the heart. In this paper, we present a variational framework for joint segmentation and registration of multiple structures of the heart. To enable the simultaneous segmentation and registration of multiple objects, a shape prior term is introduced into a region competition approach for multi-object level set segmentation. The proposed algorithm is applied for simultaneous segmentation of the myocardium as well as the left and right ventricular blood pool in short axis cine MRI images. Two experiments are performed: first, intra-patient 4D segmentation with a given initial segmentation for one time-point in a 4D sequence, and second, a multi-atlas segmentation strategy is applied to unseen patient data. Evaluation of segmentation accuracy is done by overlap coefficients and surface distances. An evaluation based on clinical 4D cine MRI images of 25 patients shows the benefit of the combined approach compared to sole registration and sole segmentation.

  15. Segmentation of Left Ventricle From 3D Cardiac MR Image Sequences Using A Subject-Specific Dynamical Model

    PubMed Central

    Papademetris, Xenophon; Sinusas, Albert; Duncan, James S.

    2009-01-01

    Statistical model-based segmentation of the left ventricle from cardiac images has received considerable attention in recent years. While a variety of statistical models have been shown to improve segmentation results, most of them are either static models (SM) which neglect the temporal coherence of a cardiac sequence or generic dynamical models (GDM) which neglect the inter-subject variability of cardiac shapes and deformations. In this paper, we use a subject-specific dynamical model (SSDM) that handles inter-subject variability and temporal dynamics (intra-subject variability) simultaneously. It can progressively identify the specific motion patterns of a new cardiac sequence based on the segmentations observed in the past frames. We formulate the integration of the SSDM into the segmentation process in a recursive Bayesian framework in order to segment each frame based on the intensity information from the current frame and the prediction from the past frames. We perform “Leave-one-out” test on 32 sequences to validate our approach. Quantitative analysis of experimental results shows that the segmentation with the SSDM outperforms those with the SM and GDM by having better global and local consistencies with the manual segmentation. PMID:20052308

  16. Serial echocardiographic left ventricular ejection fraction measurements: a tool for detecting thalassemia major patients at risk of cardiac death.

    PubMed

    Maggio, Aurelio; Vitrano, Angela; Calvaruso, Giuseppina; Barone, Rita; Rigano, Paolo; Mancuso, Luigi; Cuccia, Liana; Capra, Marcello; Pitrolo, Lorella; Prossomariti, Luciano; Filosa, Aldo; Caruso, Vincenzo; Gerardi, Calogera; Campisi, Saveria; Cianciulli, Paolo; Elefteriou, Androulla; Angastiniotis, Michel; Hamza, Hala; Telfer, Paul; Walker, John Malcolm; Phrommintikul, Arintaya; Chattipakorn, Nipon

    2013-04-01

    Cardiac damage remains a major cause of mortality among patients with thalassemia major. The detection of a lower cardiac magnetic resonance T2* (CMR-T2*) signal has been suggested as a powerful predictor of the subsequent development of heart failure. However, the lack of worldwide availability of CMR-T2* facilities prevents its widespread use for follow-up evaluations of cardiac function in thalassemia major patients, warranting the need to assess the utility of other possible procedures. In this setting, the determination of left ventricular ejection fraction (LVEF) offers an accurate and reproducible method for heart function evaluation. These findings suggest a reduction in LVEF?7%, over time, determined by 2-D echocardiography, may be considered a strong predictive tool for the detection of thalassemia major patients with increased risk of cardiac death. The reduction of LVEF?7% had higher (84.76%) predictive value. Finally, Kaplan-Meier survival curves of thalassemia major patients with LVEF?7% showed a statistically significant decreased probability of survival for heart disease (p=0.0022). However, because of limitations related to the study design, such findings should be confirmed in a large long-term prospective clinical trial. PMID:23337255

  17. Automatic segmentation of the left ventricle in cardiac MRI using local binary fitting model and dynamic programming techniques.

    PubMed

    Hu, Huaifei; Gao, Zhiyong; Liu, Liman; Liu, Haihua; Gao, Junfeng; Xu, Shengzhou; Li, Wei; Huang, Lu

    2014-01-01

    Segmentation of the left ventricle is very important to quantitatively analyze global and regional cardiac function from magnetic resonance. The aim of this study is to develop a novel algorithm for segmenting left ventricle on short-axis cardiac magnetic resonance images (MRI) to improve the performance of computer-aided diagnosis (CAD) systems. In this research, an automatic segmentation method for left ventricle is proposed on the basis of local binary fitting (LBF) model and dynamic programming techniques. The validation experiments are performed on a pool of data sets of 45 cases. For both endo- and epi-cardial contours of our results, percentage of good contours is about 93.5%, the average perpendicular distance are about 2 mm. The overlapping dice metric is about 0.91. The regression and determination coefficient between the experts and our proposed method on the LV mass is 1.038 and 0.9033, respectively; they are 1.076 and 0.9386 for ejection fraction (EF). The proposed segmentation method shows the better performance and has great potential in improving the accuracy of computer-aided diagnosis systems in cardiovascular diseases. PMID:25500580

  18. Automatic Segmentation of the Left Ventricle in Cardiac MRI Using Local Binary Fitting Model and Dynamic Programming Techniques

    PubMed Central

    Hu, Huaifei; Gao, Zhiyong; Liu, Liman; Liu, Haihua; Gao, Junfeng; Xu, Shengzhou; Li, Wei; Huang, Lu

    2014-01-01

    Segmentation of the left ventricle is very important to quantitatively analyze global and regional cardiac function from magnetic resonance. The aim of this study is to develop a novel algorithm for segmenting left ventricle on short-axis cardiac magnetic resonance images (MRI) to improve the performance of computer-aided diagnosis (CAD) systems. In this research, an automatic segmentation method for left ventricle is proposed on the basis of local binary fitting (LBF) model and dynamic programming techniques. The validation experiments are performed on a pool of data sets of 45 cases. For both endo- and epi-cardial contours of our results, percentage of good contours is about 93.5%, the average perpendicular distance are about 2 mm. The overlapping dice metric is about 0.91. The regression and determination coefficient between the experts and our proposed method on the LV mass is 1.038 and 0.9033, respectively; they are 1.076 and 0.9386 for ejection fraction (EF). The proposed segmentation method shows the better performance and has great potential in improving the accuracy of computer-aided diagnosis systems in cardiovascular diseases. PMID:25500580

  19. Computed tomographic features of congenital left ventricular diverticulum.

    PubMed

    Dwivedi, Amit N D; Thangiah, Arun G; Rai, Madhukar; Tripathi, Suchi

    2012-01-01

    Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized out-pouching from the cardiac chamber. They are most often found in the left ventricle (LV) but have been reported to occur in all chambers of the heart. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture may be the initial presentation. Diagnosis can be established by echocardiography (EKG), computed tomographic (CT) angiography, and magnetic resonance imaging (MRI). We report a case of congenital left ventricular diverticulum in an adult with no valvular abnormality as an incidental finding in an uncommon location. PMID:22919562

  20. Computed Tomographic Features of Congenital Left Ventricular Diverticulum

    PubMed Central

    Dwivedi, Amit N. D.; Thangiah, Arun G.; Rai, Madhukar; Tripathi, Suchi

    2012-01-01

    Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized out-pouching from the cardiac chamber. They are most often found in the left ventricle (LV) but have been reported to occur in all chambers of the heart. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture may be the initial presentation. Diagnosis can be established by echocardiography (EKG), computed tomographic (CT) angiography, and magnetic resonance imaging (MRI). We report a case of congenital left ventricular diverticulum in an adult with no valvular abnormality as an incidental finding in an uncommon location. PMID:22919562

  1. SU-E-J-33: Cardiac Movement in Deep Inspiration Breath-Hold for Left-Breast Cancer Radiotherapy

    SciTech Connect

    Kim, M; Lee, S; Suh, T [Department of Biomedical Engineering, Research Institute of Biomedical Engineering, Catholic University of Korea, Seoul (Korea, Republic of)

    2014-06-01

    Purpose: The present study was designed to investigate the displacement of heart using Deep Inspiration Breath Hold (DIBH) CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Methods: Treatment planning was performed on the computed tomography (CT) datasets of 20 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ? 95% of the prescribed dose and that the volume inside the CTV receiving > 107% of the prescribed dose should be minimized. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. Results: The maximum and minimum left-right (LR) displacements of heart were 8.9 mm and 3 mm, respectively. The heart moved > 4 mm in the LR direction in 17 of the 20 patients. The distances between the heart and left breast ranged from 8.02–17.68 mm (mean, 12.23 mm) and 7.85–12.98 mm (mean, 8.97 mm) with DIBH CT and FB CT, respectively. The maximum doses to the heart were 3115 cGy and 4652 cGy for the DIBH and FB CT dataset, respectively. Conclusion: The present study has demonstrated that the DIBH technique could help to reduce the risk of radiation dose-induced cardiac toxicity by using movement of cardiac; away from radiation field. The DIBH technique could be used in an actual treatment room for a few minutes and could effectively reduce the cardiac dose when used with a sub-device or image acquisition standard to maintain consistent respiratory motion.

  2. Left ventricular diastolic function in workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement

    SciTech Connect

    Por?ba, Rafa?, E-mail: sogood@poczta.onet.pl; Skoczy?ska, Anna; Ga?, Pawe?; Turczyn, Barbara; Wojakowska, Anna

    2012-09-15

    The aim of the study was to evaluate left ventricular diastolic function in workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement. The studies included 115 workers (92 men and 23 women) occupationally exposed to mercury vapour without clinical presentation of cardiac involvement (mean age: 47.83 ± 8.29). Blood samples were taken to determine blood lipid profile, urine was collected to estimate mercury concentration (Hg-U) and echocardiographic examination was performed to evaluate diastolic function of the left ventricle. In the entire group of workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement, Spearman correlations analysis demonstrated the following significant linear relationships: between body mass index (BMI) and ratio of maximal early diastolic mitral flow velocity/early diastolic mitral annular velocity (E/E') (r = 0.32, p < 0.05), between serum HDL concentration and E/E' (r = ? 0.22, p < 0.05), between Hg-U and E/E' (r = 0.35, p < 0.05), between Hg-U and isovolumetric relaxation time (IVRT') (r = 0.41, p < 0.05), between Hg-U and ratio of maximal early diastolic mitral flow velocity/maximal late diastolic mitral flow velocity (E/A) (r = ? 0.31, p < 0.05) and between serum HDL concentration and E/A (r = 0.43, p < 0,05). In logistic regression analysis it as shown that independent factors of left ventricular diastolic dysfunction risk in the study group included a higher urine mercury concentration, a higher value of BMI and a lower serum HDL concentration (OR{sub Hg}-{sub U} = 1.071, OR{sub BMI} = 1.200, OR{sub HDL} = 0.896, p < 0.05). Summing up, occupational exposure to mercury vapour may be linked to impaired left ventricular diastolic function in workers without clinical presentation of cardiac involvement. -- Highlights: ? Study aimed at evaluation of LVDD in workers occupationally exposed to Hg. ? There was significant linear relationships between Hg-U and E/E'. ? Independent risk factor of LVDD in study group included higher Hg-U. ? Independent risk factor of LVDD in study group included higher BMI and lower HDL. ? Occupational exposure to Hg may be linked to LVDD.

  3. Protease-Activated Receptor 1 Inhibition by SCH79797 Attenuates Left Ventricular Remodeling and Profibrotic Activities of Cardiac Fibroblasts

    PubMed Central

    Sonin, Dmitry L.; Wakatsuki, Tetsuro; Routhu, Kasi V.; Harmann, Leanne M.; Petersen, Matthew; Meyer, Jennifer; Strande, Jennifer L.

    2013-01-01

    Purpose Fibroblast activity promotes adverse left ventricular (LV) remodeling that underlies the development of ischemic cardiomyopathy. Transforming growth factor-? (TGF-?) is a potent stimulus for fibrosis, and the extracellular signal-regulated kinases(ERK) 1/2 pathway also contributes to the fibrotic response. The thrombin receptor, protease-activated receptor 1 (PAR1), has been shown to play an important role in the excessive fibrosis in different tissues. The aim of this study was to investigate the influence of a PAR1 inhibitor, SCH79797, on cardiac fibrosis, tissue stiffness and postinfarction remodeling, and effects of PAR1 inhibition on thrombin-induced TGF-? and (ERK) 1/2 activities in cardiac fibroblasts. Methods We used a rat model of myocardial ischemia–reperfusion injury, isolated cardiac fibroblasts, and 3-dimensional (3D) cardiac tissue models fabricated to ascertain the contribution of PAR1 activation on cardiac fibrosis and LV remodeling. Results The PAR1 inhibitor attenuated LV dilation and improved LV systolic function of the reperfused myocardium at 28 days. This improvement was associated with a nonsignificant decrease in scar size (%LV) from 23 ± % in the control group (n = 10) to 16% ± 5.5% in the treated group (n = 9; P = .052). In the short term, the PAR1 inhibitor did not rescue infarct size or LV systolic function after 3 days. The PAR1 inhibition abolished thrombin-mediated ERK1/2 phosphorylation, TGF-? and type I procollagen production, matrix metalloproteinase-2/9 activation, myofibroblasts transformation in vitro, and abrogated the remodeling of 3D tissues induced by chronic thrombin treatment. Conclusion These studies suggest PAR1 inhibition initiated after ischemic injury attenuates adverse LV remodeling through late-stage antifibrotic events. PMID:23598708

  4. Marked improvement in left ventricular function and significant reverse left ventricular remodeling within 3 months of cardiac resynchronization therapy in patients with dilated cardiomyopathy.

    PubMed

    Funck, Reinhard C; Koelsch, Susanne; Waldhans, Stefan; Prinz, Helge; Grimm, Wolfram; Moosdorf, Rainer; Maisch, Bernhard

    2005-01-01

    We monitored reverse left ventricular (LV) remodeling and LV function during the first 6 months of cardiac resynchronization therapy (CRT) in 34 patients (mean age = 55.3 +/- 13.6 years, 28 men) with dilated cardiomyopathy (DCM), left bundle branch block, in stable New York Heart Association class III, and on fixed drug regimen who underwent implantation of CRT systems with or without cardioverter defibrillator back-up. QRS-complex duration was reduced from 169.69 +/- 19.6 ms (SD) to 144.1 +/- 23.4 ms during CRT. Parasternal M-mode and apical 2D-echocardiography was performed before and 3 and 6 months after device implantation. LV enddiastolic (EDD) and endsystolic (ESD) diameters were measured, and biplane LV enddiastolic (EDV), and endsystolic (ESV) volumes and ejection fractions (EF) were calculated using a modified Simpson formula. Significant decreases in LVEDD (P = 0.0064 at 3 months and P = 0.021 at 6 months), LVESD (P = 0.023 at 3 months, and P = 0.003 at 6 months), and LVESV (P = 0.006 resp. P = 0.007), and increases in LVEF (P = 0.003 at 3 months and P < 0.001 at 6 months) were observed. Mean LVEF increased from 23% at baseline to 39% at 6 months. CRT induced prominent reverse LV remodeling and significantly increased LVEF within a few months in patients with DCM. PMID:15683524

  5. Usefulness of NT-proBNP level for diagnosing left ventricular hypertrophy in hypertensive patients. A cardiac magnetic resonance study.

    PubMed

    Morillas, Pedro; Castillo, Jesús; Quiles, Juan; Nuñez, Daniel; Guillén, Silvia; Maceira, Alicia; Rivera, Miguel; Bertomeu, Vicente

    2008-09-01

    The presence of left ventricular hypertrophy (LVH) is associated with an increase in cardiovascular morbidity and mortality in hypertensive patients. We investigated the diagnostic value of the N-terminal probrain natriuretic peptide (NT-proBNP) level for detecting LVH in hypertensive patients with a conserved left ventricular ejection fraction. The study involved 27 consecutive patients. Cardiac magnetic resonance imaging was performed to determine left ventricular mass and the plasma NT-proBNP level was measured. A significant correlation was found between the NT-proBNP level and left ventricular mass (r=0.598; P=.001). Use of a cut-off point of 35 pg/mL enabled the presence of LVH to be identified with a sensitivity of 100% (95% confidence interval [CI], 69%-100%) and a specificity of 70.6% (95% CI, 44.1%-89.6%). The area under the receiver operating characteristic (ROC) curve was 0.867 (95% CI, 0.73-1; P< .05). The plasma NT-proBNP level may be useful for identifying patients with LVH. PMID:18775240

  6. Electrical wave propagation in an anisotropic model of the left ventricle based on analytical description of cardiac architecture.

    PubMed

    Pravdin, Sergey F; Dierckx, Hans; Katsnelson, Leonid B; Solovyova, Olga; Markhasin, Vladimir S; Panfilov, Alexander V

    2014-01-01

    We develop a numerical approach based on our recent analytical model of fiber structure in the left ventricle of the human heart. A special curvilinear coordinate system is proposed to analytically include realistic ventricular shape and myofiber directions. With this anatomical model, electrophysiological simulations can be performed on a rectangular coordinate grid. We apply our method to study the effect of fiber rotation and electrical anisotropy of cardiac tissue (i.e., the ratio of the conductivity coefficients along and across the myocardial fibers) on wave propagation using the ten Tusscher-Panfilov (2006) ionic model for human ventricular cells. We show that fiber rotation increases the speed of cardiac activation and attenuates the effects of anisotropy. Our results show that the fiber rotation in the heart is an important factor underlying cardiac excitation. We also study scroll wave dynamics in our model and show the drift of a scroll wave filament whose velocity depends non-monotonically on the fiber rotation angle; the period of scroll wave rotation decreases with an increase of the fiber rotation angle; an increase in anisotropy may cause the breakup of a scroll wave, similar to the mother rotor mechanism of ventricular fibrillation. PMID:24817308

  7. Electrical Wave Propagation in an Anisotropic Model of the Left Ventricle Based on Analytical Description of Cardiac Architecture

    PubMed Central

    Pravdin, Sergey F.; Dierckx, Hans; Katsnelson, Leonid B.; Solovyova, Olga; Markhasin, Vladimir S.; Panfilov, Alexander V.

    2014-01-01

    We develop a numerical approach based on our recent analytical model of fiber structure in the left ventricle of the human heart. A special curvilinear coordinate system is proposed to analytically include realistic ventricular shape and myofiber directions. With this anatomical model, electrophysiological simulations can be performed on a rectangular coordinate grid. We apply our method to study the effect of fiber rotation and electrical anisotropy of cardiac tissue (i.e., the ratio of the conductivity coefficients along and across the myocardial fibers) on wave propagation using the ten Tusscher–Panfilov (2006) ionic model for human ventricular cells. We show that fiber rotation increases the speed of cardiac activation and attenuates the effects of anisotropy. Our results show that the fiber rotation in the heart is an important factor underlying cardiac excitation. We also study scroll wave dynamics in our model and show the drift of a scroll wave filament whose velocity depends non-monotonically on the fiber rotation angle; the period of scroll wave rotation decreases with an increase of the fiber rotation angle; an increase in anisotropy may cause the breakup of a scroll wave, similar to the mother rotor mechanism of ventricular fibrillation. PMID:24817308

  8. A Voluntary Breath-Hold Treatment Technique for the Left Breast With Unfavorable Cardiac Anatomy Using Surface Imaging

    SciTech Connect

    Gierga, David P., E-mail: dgierga@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Harvard Medical School, Boston, Massachusetts (United States); Turcotte, Julie C. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)] [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Sharp, Gregory C. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States) [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Harvard Medical School, Boston, Massachusetts (United States); Sedlacek, Daniel E.; Cotter, Christopher R. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)] [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Taghian, Alphonse G. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States) [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Harvard Medical School, Boston, Massachusetts (United States)

    2012-12-01

    Purpose: Breath-hold (BH) treatments can be used to reduce cardiac dose for patients with left-sided breast cancer and unfavorable cardiac anatomy. A surface imaging technique was developed for accurate patient setup and reproducible real-time BH positioning. Methods and Materials: Three-dimensional surface images were obtained for 20 patients. Surface imaging was used to correct the daily setup for each patient. Initial setup data were recorded for 443 fractions and were analyzed to assess random and systematic errors. Real time monitoring was used to verify surface placement during BH. The radiation beam was not turned on if the BH position difference was greater than 5 mm. Real-time surface data were analyzed for 2398 BHs and 363 treatment fractions. The mean and maximum differences were calculated. The percentage of BHs greater than tolerance was calculated. Results: The mean shifts for initial patient setup were 2.0 mm, 1.2 mm, and 0.3 mm in the vertical, longitudinal, and lateral directions, respectively. The mean 3-dimensional vector shift was 7.8 mm. Random and systematic errors were less than 4 mm. Real-time surface monitoring data indicated that 22% of the BHs were outside the 5-mm tolerance (range, 7%-41%), and there was a correlation with breast volume. The mean difference between the treated and reference BH positions was 2 mm in each direction. For out-of-tolerance BHs, the average difference in the BH position was 6.3 mm, and the average maximum difference was 8.8 mm. Conclusions: Daily real-time surface imaging ensures accurate and reproducible positioning for BH treatment of left-sided breast cancer patients with unfavorable cardiac anatomy.

  9. Regional Analysis of Left Ventricle Function using a Cardiac-Specific Polyaffine Motion

    E-print Network

    Paris-Sud XI, Université de

    into congestive heart failure is increasingly providing new solutions to extend the life expectancy of heart failure patients. Given that cardiac asynchronous contrac- tion is seen as a key characteristic of heart in a given region, or regions) can significantly reduce the risk of death in heart failure patients. Common

  10. Kinematic analysis of left ventricular deformation in myocardial infarction using magnetic resonance cardiac tagging

    Microsoft Academic Search

    Frank W. L. Aelen; Theo Arts; Dave G. M. Sanders; Guillaume R. P. Thelissen; Frits W. Prinzen; Robert S. Reneman

    1999-01-01

    The Magnetic Resonance (MR) tagging technique provides detailed information about 2D motion in the plane of observation. Interpretation of this information as a reflection of the 3D motion of the entire cardiac wall is a major problem. In finite element models of the mechanics of the infarcted heart, an infarcted region causes motional asymmetry, extending far beyond the infarct boundary.

  11. Segmentation of the Left Ventricle from Cardiac MR Images Using a Subject-Specific Dynamical Model

    PubMed Central

    Zhu, Yun; Papademetris, Xenophon; Sinusas, Albert J.; Duncan, James S.

    2009-01-01

    Statistical models have shown considerable promise as a basis for segmenting and interpreting cardiac images. While a variety of statistical models have been proposed to improve the segmentation results, most of them are either static models (SM),which neglect the temporal dynamics of a cardiac sequence or generic dynamical models (GDM), which are homogeneous in time and neglect the inter-subject variability in cardiac shape and deformation. In this paper, we develop a subject-specific dynamical model (SSDM) that simultaneously handles temporal dynamics (intra-subject variability) and inter-subject variability. We also propose a dynamic prediction algorithm that can progressively identify the specific motion patterns of a new cardiac sequence based on the shapes observed in past frames. The incorporation of this SSDM into the segmentation framework is formulated in a recursive Bayesian framework. It starts with a manual segmentation of the first frame, and then segments each frame according to intensity information from the current frame as well as the prediction from past frames. In addition, to reduce error propagation in sequential segmentation, we take into account the periodic nature of cardiac motion and perform segmentation in both forward and backward directions. We perform “Leave-one-out” test on 32 canine sequences and 22 human sequences, and compare the experimental results with those from SM, GDM, and Active Appearance Motion Model (AAMM). Quantitative analysis of the experimental results shows that SSDM outperforms SM, GDM, and AAMM by having better global and local consistencies with manual segmentation. Moreover, we compare the segmentation results from forward and forward-backward segmentation. Quantitative evaluation shows that forward-backward segmentation suppresses the propagation of segmentation errors. PMID:19789107

  12. Contrast-enhanced cardiac C-arm CT evaluation of radiofrequency ablation lesions in the left ventricle

    PubMed Central

    Girard, Erin E; Al-Ahmad, Amin A; Rosenberg, Jarrett; Luong, Richard; Moore, Teri; Lauritsch, Günter; Boese, Jan; Fahrig, Rebecca

    2011-01-01

    Objectives The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure. Background Both magnetic resonance imaging (MRI) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RF ablation lesions with MRI, however obtaining MR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures. Methods RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RF ablation catheter. An ECG-gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and following the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and standard deviation of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images. Results All ablation lesions (n=29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (1D dimensions : concordance correlation = 0.87; area : concordance correlation = 0.90). Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity 95 HU lower than normal myocardium (95% confidence interval: -111 to -79 HU). Images acquired at 1 and 5 minutes exhibited an enhancing ring surrounding the perfusion defect in 24 (83%) lesions. Conclusions RFA lesion size, including transmurality, can be assessed using ECG-gated cardiac C-arm CT in the interventional suite. Visualization of RFA lesions using cardiac C-arm CT may facilitate the assessment of adequate lesion delivery and provide valuable feedback during cardiac ablation procedures. PMID:21414574

  13. The deep inspiration breath hold technique using Abches reduces cardiac dose in patients undergoing left-sided breast irradiation

    PubMed Central

    Lee, Ha Yoon; Chang, Jee Suk; Lee, Ik Jae; Park, Kwangwoo; Kim, Yong Bae; Suh, Chang Ok; Kim, Jun Won

    2013-01-01

    Purpose We explored whether the deep inspiration breath hold (DIBH) technique using Abches during left-sided breast irradiation was effective for minimizing the amount of radiation to the heart and lung compared to free breathing (FB). Materials and Methods Between February and July 2012, a total of 25 patients with left-sided breast cancer underwent two computed tomography scans each with the DIBH using Abches and using FB after breast-conserving surgery. The scans were retrospectively replanned using standardized criteria for the purpose of this study. The DIBH plans for each patient were compared with FB plans using dosimetric parameters. Results All patients were successfully treated with the DIBH technique using Abches. Significant differences were found between the DIBH and FB plans for mean heart dose (2.52 vs. 4.53 Gy), heart V30 (16.48 vs. 45.13 cm3), V20 (21.35 vs. 54.55 cm3), mean left anterior descending coronary artery (LAD) dose (16.01 vs. 26.26 Gy, all p < 0.001), and maximal dose to 0.2 cm3 of the LAD (41.65 vs. 47.27 Gy, p = 0.017). The mean left lung dose (7.53 vs. 8.03 Gy, p = 0.073) and lung V20 (14.63% vs. 15.72%, p = 0.060) of DIBH using Abches were not different significantly compared with FB. Conclusion We report that the use of a DIBH technique using Abches in breathing adapted radiotherapy for left-sided breast cancer is easily feasible in daily practice and significantly reduces the radiation doses to the heart and LAD, therefore potentially reducing cardiac risk. PMID:24501713

  14. Cardiac dose reduction with breathing adapted radiotherapy using self respiration monitoring system for left-sided breast cancer

    PubMed Central

    Sung, KiHoon; Lee, Seung Heon; Ahn, So Hyun; Lee, Seok Ho; Choi, Jinho

    2014-01-01

    Purpose To quantify the cardiac dose reduction during breathing adapted radiotherapy using Real-time Position Management (RPM) system in the treatment of left-sided breast cancer. Materials and Methods Twenty-two patients with left-sided breast cancer underwent CT scans during breathing maneuvers including free breathing (FB), deep inspiration breath-hold (DIBH), and end inspiration breath-hold (EIBH). The RPM system was used to monitor respiratory motion, and the in-house self respiration monitoring (SRM) system was used for visual feedback. For each scan, treatment plans were generated and dosimetric parameters from DIBH and EIBH plans were compared to those of FB plans. Results All patients completed CT scans with different breathing maneuvers. When compared with FB plans, DIBH plans demonstrated significant reductions in irradiated heart volume and the heart V25, with the relative reduction of 71% and 70%, respectively (p < 0.001). EIBH plans also resulted in significantly smaller irradiated heart volume and lower heart V25 than FB plans, with the relative reduction of 39% and 37%, respectively (p = 0.002). Despite of significant expansion of lung volume using inspiration breath-hold, there were no significant differences in left lung V25 among the three plans. Conclusion In comparison with FB, both DIBH and EIBH plans demonstrated a significant reduction of radiation dose to the heart. In the training course, SRM system was useful and effective in terms of positional reproducibility and patient compliance. PMID:25061577

  15. Markov random field modeling for three-dimensional reconstruction of the left ventricle in cardiac angiography

    Microsoft Academic Search

    Rubén Medina; Mireille Garreau; Javier Toro; Hervé Le Breton; Jean-louis Coatrieux; Diego Jugo

    2006-01-01

    This paper reports on a method for left ventricle three-dimensional reconstruction from two orthogonal ventriculo- grams. The proposed algorithm is voxel-based and takes into account the conical projection geometry associated with the biplane image acquisition equipment. The reconstruction process starts with an initial ellipsoidal approximation derived from the input ventriculograms. This model is subsequently deformed in such a way as

  16. Cardiac and Metabolic Effects of Anabolic-Androgenic Steroid Abuse on Lipids, Blood Pressure, Left Ventricular Dimensions, and Rhythm

    PubMed Central

    Achar, Suraj; Rostamian, Armand; Narayan, Sanjiv M.

    2014-01-01

    Recent surveys and reports suggest that many athletes and bodybuilders abuse anabolic-androgenic steroids (AAS). However, scientific data on the cardiac and metabolic complications of AAS abuse are divergent and often conflicting. A total of 49 studies describing 1,467 athletes were reviewed to investigate the cardiovascular effects of the abuse of AAS. Although studies were typically small and retrospective, some associated AAS abuse with unfavorable effects. Otherwise healthy young athletes abusing AAS may show elevated levels of low-density lipoprotein and low levels of high-density lipoprotein. Although data are conflicting, AAS have also been linked with elevated systolic and diastolic blood pressure and with left ventricular hypertrophy that may persist after AAS cessation. Finally, in small case studies, AAS abuse has been linked with acute myocardial infarction and fatal ventricular arrhythmias. In conclusion, recognition of these adverse effects may improve the education of athletes and increase vigilance when evaluating young athletes with cardiovascular abnormalities. PMID:20816133

  17. Cardiac CD47 Drives Left Ventricular Heart Failure Through Ca2+?CaMKII?Regulated Induction of HDAC3

    PubMed Central

    Sharifi?Sanjani, Maryam; Shoushtari, Ali Hakim; Quiroz, Marisol; Baust, Jeffrey; Sestito, Samuel F.; Mosher, Mackenzie; Ross, Mark; McTiernan, Charles F.; St. Croix, Claudette M.; Bilonick, Richard A.; Champion, Hunter C.; Isenberg, Jeffrey S.

    2014-01-01

    Background Left ventricular heart failure (LVHF) remains progressive and fatal and is a formidable health problem because ever?larger numbers of people are diagnosed with this disease. Therapeutics, while relieving symptoms and extending life in some cases, cannot resolve this process and transplant remains the option of last resort for many. Our team has described a widely expressed cell surface receptor (CD47) that is activated by its high?affinity secreted ligand, thrombospondin 1 (TSP1), in acute injury and chronic disease; however, a role for activated CD47 in LVHF has not previously been proposed. Methods and Results In experimental LVHF TSP1?CD47 signaling is increased concurrent with up?regulation of cardiac histone deacetylase 3 (HDAC3). Mice mutated to lack CD47 displayed protection from transverse aortic constriction (TAC)?driven LVHF with enhanced cardiac function, decreased cellular hypertrophy and fibrosis, decreased maladaptive autophagy, and decreased expression of HDAC3. In cell culture, treatment of cardiac myocyte CD47 with a TSP1?derived peptide, which binds and activates CD47, increased HDAC3 expression and myocyte hypertrophy in a Ca2+/calmodulin protein kinase II (CaMKII)?dependent manner. Conversely, antibody blocking of CD47 activation, or pharmacologic inhibition of CaMKII, suppressed HDAC3 expression, decreased myocyte hypertrophy, and mitigated established LVHF. Downstream gene suppression of HDAC3 mimicked the protective effects of CD47 blockade and decreased hypertrophy in myocytes and mitigated LVHF in animals. Conclusions These data identify a proximate role for the TSP1?CD47 axis in promoting LVHF by CaKMII?mediated up?regulation of HDAC3 and suggest novel therapeutic opportunities. PMID:24922625

  18. Relation of reduced preclinical left ventricular diastolic function and cardiac remodeling in overweight youth to insulin resistance and inflammation.

    PubMed

    Dahiya, Rachana; Shultz, Sarah P; Dahiya, Arun; Fu, Jinlin; Flatley, Christopher; Duncan, Danusia; Cardinal, John; Kostner, Karam M; Byrne, Nuala M; Hills, Andrew P; Harris, Mark; Conwell, Louise S; Leong, Gary M

    2015-05-01

    Insulin resistance (IR) and inflammation are associated with an increased risk of cardiovascular disease and may contribute to obesity cardiomyopathy. The earliest sign of obesity cardiomyopathy is impaired left ventricular (LV) diastolic function, which may be evident in obese children and adolescents. However, the precise metabolic basis of the impaired LV diastolic function remains unknown. The aims of this study were to evaluate cardiac structure and LV diastolic function by tissue Doppler imaging in overweight and obese (OW) youth and to assess the relative individual contributions of adiposity, IR, and inflammation to alterations in cardiac structure and function. We studied 35 OW (body mass index standard deviation score 2.0 ± 0.8; non-IR n = 19, IR n = 16) and 34 non-OW youth (body mass index standard deviation score 0.1 ± 0.7). LV diastolic function was reduced in OW youth compared with non-OW controls, as indicated by lower peak myocardial relaxation velocities (p <0.001) and greater filling pressures (p <0.001). OW youth also had greater LV mass index (p <0.001), left atrial volume index, and LV interventricular septal thickness (LV-IVS; both p = 0.02). IR-OW youth had the highest LV filling pressures, LV-IVS, and relative wall thickness (all p <0.05). Homeostasis model of assessment-insulin resistance and C-reactive protein were negative determinants of peak myocardial relaxation velocity and positive predictors of filling pressure. Adiponectin was a negative determinant of LV-IVS, independent of obesity. In conclusion, OW youth with IR and inflammation are more likely to have adverse changes to cardiovascular structure and function which may predispose to premature cardiovascular disease in adulthood. PMID:25765589

  19. Comparison of QT Dispersion With Left Ventricular Mass Index in Early Diagnosis of Cardiac Dysfunction in Patients With ?-Thalassemia Major

    PubMed Central

    Noori, Noor Mohammad; Mahjoubifard, Maziar; Mohammadi, Mehdi; Jahangiri Fard, Alireza; Abassi, Abdolhossein; Farzanegan, Behrooz

    2014-01-01

    Background: In electrocardiography (ECG), QT is the interval between the onset of Q wave to the end of the T wave. This interval may be a sign of changes in the ventricular structure in hematologic disorders such as thalassemia major. Objectives: The main goal of this study was to compare the diagnostic value of corrected QT dispersion (QTcd) and QT dispersion (QTd) with left ventricular mass (LVM) and left ventricular mass index (LVMI) as well as to determine their sensitivity and specificity in early detection of the cardiac involvement in patients with ?-thalassemia major. Patients and Methods: In a case-control study, 60 patients older than ten years of age with thalassemia major who received regular blood transfusion and iron chelators were selected as the case group and were compared with 60 healthy age- and sex-matched subjects. All patients had myocardial performance index (MPI) of more than 0.5 and MPI for controls was less than 0.5. Echocardiography and ECG were performed for both groups and data were analyzed using appropriate statistical tests. Results: The mean age of cases and controls were 16 ± 2.8 and 16.08 ± 3.01 years, respectively. Male to female ratio was 33:27 in case group and 31:29 in the control group. LVMI in the case group was greater than control group. QTd and QTcd were larger in case group than in control group. The sensitivity and specificity of LVM, LVMI, QTd, and QTcd were as follows: 88.3%, 77.1%; 86.7%, 80%; 93.8%, 80%; and 91.7%, 86.7%, respectively. Conclusions: This study showed acceptable sensitivity and specificity of QTcd and QTd in comparison to LVMI; it seems that standard ECG can be used for early diagnosis of cardiac involvement in asymptomatic patients with thalassemia major. PMID:25031849

  20. The role of cardiac biomarkers for predicting left ventricular dysfunction and cardiovascular mortality in acute exacerbations of COPD

    PubMed Central

    Bennett, Ruth; Coad, Anna; Barnes, Simon; Russell, Richard; Manuel, Ari R

    2015-01-01

    The presence of cardiovascular comorbidities is frequently associated with poor outcomes in chronic obstructive pulmonary disease (COPD). No clear role has been defined for cardiac biomarkers in acute exacerbations of COPD (AECOPD). The aim of this systematic review was to examine the prognostic value of brain natriuretic peptide (BNP) and troponins in patients with AECOPD. Two independent authors searched the PubMed and Cochrane Library to collect clinical trials, observational studies and meta-analyses studying the prognostic value of cardiac biomarkers in AECOPD. The reference lists of all the included studies were also reviewed. A total of 14 studies were included in the review, of which 10 measured troponins, 7 measured BNP or NT-proBNP, and 3 measured both. Of the studies that used mortality in AECOPD as an end point, some but not all found that elevated BNP and/or troponins were associated with increased mortality. Of the studies that used left ventricular (LV) dysfunction in AECOPD as an end point, all found a significant association between elevated BNP and troponins in the diagnosis of LV dysfunction. In summary, it appears that there may be a link between an elevated level of BNP or NT-proBNP and increased cardiovascular mortality in AECOPD, although the data currently available are not conclusive. The inconsistencies in biomarkers measured, time points of measurements and the variability in outcome measured preclude more robust analysis.

  1. Two-domain mechanics of a spherical, single chamber heart with applications to specific cardiac pathologies.

    PubMed

    Puwal, Steffan

    2013-12-01

    Continuum approximations of tissue consider responses averaged over many cells in a region. This simplified approach allows consideration of macroscopic effects, such as deformation or action potential propagation. A bidomain (sometimes known as biphasic) approach retains the macroscopic character of a continuum approximation while allowing one to consider microscopic effects; novel behavior arising from interactions between the intracellular and extracellular spaces can also be noted. I consider a spherical, single chamber heart with the new mechanical bidomain model in four separate pathologies: hypertension, hypovolemic hypotension, and hypertrophic and dilational cardiomyopathies. Analytic solutions of intracellular and extracellular displacements and hydrostatic pressures are presented; the distributions describe elastic deformation and hydrostatic fluid pressure buildup of the extracellular collagen matrix and the intracellular muscle under simplified spherical geometry. Potential applications, such as stretch activated membrane channels, are also noted. PMID:23875126

  2. The effect of disease on human cardiac protein expression profiles in paired samples from right and left ventricles

    PubMed Central

    2014-01-01

    Background Cardiac diseases (e.g. coronary and valve) are associated with ventricular cellular remodeling. However, ventricular biopsies from left and right ventricles from patients with different pathologies are rare and thus little is known about disease-induced cellular remodeling in both sides of the heart and between different diseases. We hypothesized that the protein expression profiles between right and left ventricles of patients with aortic valve stenosis (AVS) and patients with coronary artery disease (CAD) are different and that the protein profile is different between the two diseases. Left and right ventricular biopsies were collected from patients with either CAD or AVS. The biopsies were processed for proteomic analysis using isobaric tandem mass tagging and analyzed by reverse phase nano-LC-MS/MS. Western blot for selected proteins showed strong correlation with proteomic analysis. Results Proteomic analysis between ventricles of the same disease (intra-disease) and between ventricles of different diseases (inter-disease) identified more than 500 proteins detected in all relevant ventricular biopsies. Comparison between ventricles and disease state was focused on proteins with relatively high fold (±1.2 fold difference) and significant (P?left and right ventricles were largely structural for AVS patients and largely signaling/metabolism for CAD. Proteins commonly associated with hypertrophy were also different in the AVS group but with lower fold difference. Inter-disease differences between left ventricles of AVS and CAD were detected in 9 proteins. However, inter-disease differences between the right ventricles of CAD and AVS patients were associated with differences in 73 proteins. The majority of proteins which had a significant difference in one ventricle compared to the other pathology also had a similar trend in the adjacent ventricle. Conclusions This work demonstrates for the first time that left and right ventricles have a different proteome and that the difference is dependent on the type of disease. Inter-disease differential expression was more prominent for right ventricles. The finding that a protein change in one ventricle was often associated with a similar trend in the adjacent ventricle for a large number of proteins suggests cross-talk proteome remodeling between adjacent ventricles. PMID:25249829

  3. Computational modeling of volumetric soft tissue growth: application to the cardiac left ventricle.

    PubMed

    Kroon, Wilco; Delhaas, Tammo; Arts, Theo; Bovendeerd, Peter

    2009-08-01

    As an initial step to investigate stimulus-response relations in growth and remodeling (G&R) of cardiac tissue, this study aims to develop a method to simulate 3D-inhomogeneous volumetric growth. Growth is regarded as a deformation that is decomposed into a plastic component which describes unconstrained growth and an elastic component to satisfy continuity of the tissue after growth. In current growth models, a single reference configuration is used that remains fixed throughout the entire growth process. However, considering continuous turnover to occur together with growth, such a fixed reference is unlikely to exist in reality. Therefore, we investigated the effect of tissue turnover on growth by incrementally updating the reference configuration. With both a fixed reference and an updated reference, strain-induced cardiac growth in magnitude of 30% could be simulated. However, with an updated reference, the amplitude of the stimulus for growth decreased over time, whereas with a fixed reference this amplitude increased. We conclude that, when modeling volumetric growth, the choice of the reference configuration is of great importance for the computed growth. PMID:18758835

  4. Regression of Cardiac Hypertrophy Normalizes Glucose Metabolism and Left Ventricular Function During Reperfusion

    Microsoft Academic Search

    Richard B. Wambolt; Sarah L. Henning; Dean R. English; Gregory P. Bondy; Michael F. Allard

    1997-01-01

    It is not yet known if the alterations in myocardial glucose metabolism and the exaggerated left ventricular dysfunction that occur during reperfusion in hypertrophied hearts are reversible. Thus, we studied isolated working hearts from aortic-banded (n=29) and sham-operated control (n=32) male Sprague–Dawley rats with or without enalapril maleate treatment (25.6±0.8 mg\\/kg per day, p.o.) to determine the effect of regression

  5. Oxidative and proteolytic profiles of the right and left heart in a model of cancer-induced cardiac cachexia.

    PubMed

    Borges, F H; Marinello, P C; Cecchini, A L; Blegniski, F P; Guarnier, F A; Cecchini, R

    2014-11-01

    Cardiac cachexia is a syndrome that has received increased attention in recent years. Although an association between proteolysis and cardiac cachexia has been proposed, the direct influence of oxidative stress on the process has not been demonstrated. In the present study, the right (RH) and left (LH) hearts (atrium and ventricle of each side of the heart) were collected from rats at the 5th and 10th days after phosphate buffer (control) orWalker-256 solid tumour implantation. Immediately after sacrifice, cachexia was determined in tumour-bearing animals by the formula: [(inicial body weight-final body weight+tumour weight+weight gain of control group)/(initial body weight+body mass gain of control group)]×100%; RH and LH were stored until use. Oxidative stress and proteolysis were determined in each collected sample. In addition, heart samples were collected from a separate set of animals to determine the thickness of the left and right ventricles. Cachexia values increased over time after tumour implantation from 6.85% at the 5th day to 17.76% at the 10th day. There was no significant difference in LH wet weight and ventricle thickness compared with the control, where as RH wet weight (0.109±0.09g at the 5th day and 0.093±0.09g at the 10th day) and thickness (420±16?m at the 5th day and 279±08?m at the 10th day) were significantly decreased at both time points when compared with control values (0.153±0.06g and 607±21?m, respectively). tert-Butyl-stimulated chemiluminescence analysis revealed a significant increase in the LH and decrease in the RH oxidative stress profiles. Carbonylated proteins increased in the LH (140%, p<0.05) and RH (100%, p<0.05) at the 5th day, and significantly decreased in both sides on the 10th day compared to controls. Chemotrypsin-like, caspase-like, and calpain-like activities were evaluated by chemiluminescence, and only calpain-like activity was found to increase at the 5th day in the RH. In the LH, all proteolytic activities systems were decreased when compared with controls. Together, these results demonstrate that oxidative stress appears to play a different role in mass modulation on the LH and RH. The proteolytic systems evaluated herein also appear to have different effects on the responses developed during cardiac cachexia in the two sides of the heart. PMID:24996969

  6. Zic3 is required in the extra-cardiac perinodal region of the lateral plate mesoderm for left-right patterning and heart development

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mutations in ZIC3 cause human X-linked heterotaxy and isolated cardiovascular malformations. A mouse model with targeted deletion of Zic3 demonstrates an early role for Zic3 in gastrulation, CNS, cardiac and left-right axial development. The observation of multiple malformations in Zic3(null) mice a...

  7. Optimal use of left ventriculography at the time of cardiac catheterization: a consensus statement from the society for cardiovascular angiography and interventions.

    PubMed

    Gigliotti, Osvaldo S; Babb, Joseph D; Dieter, Robert S; Feldman, Dmitriy N; Islam, Ashequl M; Marmagkiolis, Konstantinos; Moore, Phillip; Sorajja, Paul; Blankenship, James C

    2015-02-01

    The rationale to perform left ventriculography at the time of cardiac catheterization has been little studied. The technique and frequency of use of left ventriculography vary by geographic regions, institutions, and individuals. Despite the recent publication of guidelines and appropriate use criteria for coronary angiography, revascularization, and noninvasive imaging, to date there have been no specific guidelines on the performance of left ventriculography. When left ventriculography is performed, proper technique must be used to generate high quality data which can direct patient management. The decision to perform left ventriculography in place of, or in addition to, other forms of ventricular assessment should be made taking into account the clinical context and the type of information each study provides. This paper attempts to show the role of left ventriculography at the time of coronary angiography or left heart catheterization. The recommendations in this document are not formal guidelines but are based on the consensus of this writing group. These recommendations should be tested through clinical research studies. Until such studies are performed, the writing group believes that adoption of these recommendations will lead to a more standardized application of ventriculography and improve the quality of care provided to cardiac patients. © 2014 Wiley Periodicals, Inc. PMID:25370476

  8. Dipyridamole-thallium tests are predictive of severe cardiac arrhythmias in patients with left ventricular hypertrophy

    SciTech Connect

    Saragoca, M.A.; Canziani, M.E.; Gil, M.A.; Castiglioni, M.L.; Cassiolato, J.L.; Barbieri, A.; Lima, V.C.; Draibe, S.A.; Martinez, E.E. (Cardiology Division, Escola Paulista de Medicina, Sao Paulo (Brazil))

    1991-01-01

    In a population of patients with chronic renal failure (CRF) and a high prevalence of left ventricular hypertrophy (LVH) undergoing chronic hemodialysis, the authors investigated the association between the results of dipyridamole-thallium tests (DTTs) and the occurrence of ventricular arrhythmias. They observed a positive significant association between positive DTTs and the occurrence of severe forms of ventricular arrhythmias. A significant association was also observed between the presence of severe LVH and the occurrence of severe ventricular arrhythmias. However, no association was found between the presence of LVH and the positivity of the DTT. As most of their patients with positive DTTs had unimpaired coronary circulations, they conclude that positive DTTs, although falsely indicative of impaired myocardial blood supply, does have an important clinical relevance, indicating increased risk of morbidity (and, possibly, mortality) due to ventricular arrhythmias in a population of CRF patients submitted to chronic renal function replacement program.

  9. Diacerein Improves Left Ventricular Remodeling and Cardiac Function by Reducing the Inflammatory Response after Myocardial Infarction

    PubMed Central

    Torina, Anali Galluce; Reichert, Karla; Lima, Fany; de Souza Vilarinho, Karlos Alexandre; de Oliveira, Pedro Paulo Martins; do Carmo, Helison Rafael Pereira; de Carvalho, Daniela Diógenes; Saad, Mário José Abdalla; Sposito, Andrei Carvalho; Petrucci, Orlando

    2015-01-01

    Background The inflammatory response has been implicated in the pathogenesis of left ventricular (LV) remodeling after myocardial infarction (MI). An anthraquinone compound with anti-inflammatory properties, diacerein inhibits the synthesis and activity of pro-inflammatory cytokines, such as tumor necrosis factor and interleukins 1 and 6. The purpose of this study was to investigate the effects of diacerein on ventricular remodeling in vivo. Methods and Results Ligation of the left anterior descending artery was used to induce MI in an experimental rat model. Rats were divided into two groups: a control group that received saline solution (n = 16) and a group that received diacerein (80 mg/kg) daily (n = 10). After 4 weeks, the LV volume, cellular signaling, caspase 3 activity, and nuclear factor kappa B (NF-?B) transcription were compared between the two groups. After 4 weeks, end-diastolic and end-systolic LV volumes were reduced in the treatment group compared to the control group (p < .01 and p < .01, respectively). Compared to control rats, diacerein-treated rats exhibited less fibrosis in the LV (14.65%± 7.27% vs. 22.57%± 8.94%; p < .01), lower levels of caspase-3 activity, and lower levels of NF-?B p65 transcription. Conclusions Treatment with diacerein once a day for 4 weeks after MI improved ventricular remodeling by promoting lower end-systolic and end-diastolic LV volumes. Diacerein also reduced fibrosis in the LV. These effects might be associated with partial blockage of the NF-?B pathway. PMID:25816098

  10. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    PubMed Central

    Rettmann, Maryam E.; Holmes, David R.; Kwartowitz, David M.; Gunawan, Mia; Johnson, Susan B.; Camp, Jon J.; Cameron, Bruce M.; Dalegrave, Charles; Kolasa, Mark W.; Packer, Douglas L.; Robb, Richard A.

    2014-01-01

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamic in vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration provided the noise in the surface points is not excessively high. Increased variability on the landmark fiducials resulted in increased registration errors; however, refinement of the initial landmark registration by the surface-based algorithm can compensate for small initial misalignments. The surface-based registration algorithm is quite robust to noise on the surface points and continues to improve landmark registration even at high levels of noise on the surface points. Both the canine and patient studies also demonstrate that combined landmark and surface registration has lower errors than landmark registration alone. Conclusions: In this work, we describe a model for evaluating the impact of noise variability on the input parameters of a registration algorithm in the context of cardiac ablation therapy. The model can be used to predict both registration error as well as assess which inputs have the largest effect on registration accuracy. PMID:24506630

  11. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    SciTech Connect

    Rettmann, Maryam E., E-mail: rettmann.maryam@mayo.edu; Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A. [Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States)] [Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Kwartowitz, David M. [Department of Bioengineering, Clemson University, Clemson, South Carolina 29634 (United States)] [Department of Bioengineering, Clemson University, Clemson, South Carolina 29634 (United States); Gunawan, Mia [Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C. 20057 (United States)] [Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C. 20057 (United States); Johnson, Susan B.; Packer, Douglas L. [Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905 (United States)] [Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905 (United States); Dalegrave, Charles [Clinical Cardiac Electrophysiology, Cardiology Division Hospital Sao Paulo, Federal University of Sao Paulo, 04024-002 Brazil (Brazil)] [Clinical Cardiac Electrophysiology, Cardiology Division Hospital Sao Paulo, Federal University of Sao Paulo, 04024-002 Brazil (Brazil); Kolasa, Mark W. [David Grant Medical Center, Fairfield, California 94535 (United States)] [David Grant Medical Center, Fairfield, California 94535 (United States)

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration provided the noise in the surface points is not excessively high. Increased variability on the landmark fiducials resulted in increased registration errors; however, refinement of the initial landmark registration by the surface-based algorithm can compensate for small initial misalignments. The surface-based registration algorithm is quite robust to noise on the surface points and continues to improve landmark registration even at high levels of noise on the surface points. Both the canine and patient studies also demonstrate that combined landmark and surface registration has lower errors than landmark registration alone. Conclusions: In this work, we describe a model for evaluating the impact of noise variability on the input parameters of a registration algorithm in the context of cardiac ablation therapy. The model can be used to predict both registration error as well as assess which inputs have the largest effect on registration accuracy.

  12. Markov random field modeling for three-dimensional reconstruction of the left ventricle in cardiac angiography.

    PubMed

    Medina, Rubén; Garreau, Mireille; Toro, Javier; Breton, Hervé L; Coatrieux, Jean-Louis; Jugo, Diego

    2006-08-01

    This paper reports on a method for left ventricle three-dimensional (3-D) reconstruction from two orthogonal ventriculograms. The proposed algorithm is voxel-based and takes into account the conical projection geometry associated with the biplane image acquisition equipment. The reconstruction process starts with an initial ellipsoidal approximation derived from the input ventriculograms. This model is subsequently deformed in such a way as to match the input projections. To this end, the object is modeled as a 3-D Markov-Gibbs random field, and an energy function is defined so that it includes one term that models the projections compatibility and another one that includes the space-time regularity constraints. The performance of this reconstruction method is evaluated by considering the reconstruction of mathematically synthesized phantoms and two 3-D binary databases from two orthogonal synthesized projections. The method is also tested using real biplane ventriculograms. In this case, the performance of the reconstruction is expressed in terms of the projection error, which attains values between 9.50% and 11.78 % for two biplane sequences including a total of 55 images. PMID:16895001

  13. Markov random field modeling for three-dimensional reconstruction of the left ventricle in cardiac angiography

    PubMed Central

    Medina, Rubén; Garreau, Mireille; Toro, Javier; Le Breton, Hervé; Coatrieux, Jean-Louis; Jugo, Diego

    2006-01-01

    This paper reports on a method for left ventricle three-dimensional reconstruction from two orthogonal ventriculograms. The proposed algorithm is voxel-based and takes into account the conical projection geometry associated with the biplane image acquisition equipment. The reconstruction process starts with an initial ellipsoidal approximation derived from the input ventriculograms. This model is subsequently deformed in such a way as to match the input projections. To this end, the object is modeled as a three-dimensional Markov-Gibbs random field, and an energy function is defined so that it includes one term that models the projections compatibility and another one that includes the space–time regularity constraints. The performance of this reconstruction method is evaluated by considering the reconstruction of mathematically synthesized phantoms and two 3-D binary databases from two orthogonal synthesized projections. The method is also tested using real biplane ventriculograms. In this case, the performance of the reconstruction is expressed in terms of the projection error, which attains values between 9.50% and 11.78 % for two biplane sequences including a total of 55 images. PMID:16895001

  14. [Contractility of the left ventricle of the human heart noninvasive measurement in each cardiac cycle].

    PubMed

    Khaiutin, V M; Lukoshkova, E V; Ermishkin, V V; Sonina, R S

    2010-01-01

    History of development of the method of measurement of duration of the preejection (DPE) period - characteristic of left ventricular (LV) contractility is presented. On the basis of physiological prerequisites a novel computerized method of DPE measurement in each consecutive cardiocycle has been created. Distinct features of this method are: 1) principle of measurement - tetrapolar impedancemetry, with signal electrodes located along projection of the ascending aorta, one in the center of presternum, second - 5 cm caudally; 2) starting point for DPE counting - the point on ascending portion of R wave of electrocardiogram at which the first derivative of ECG signal reaches maximum, stopping point - the point of maximum of the second derivative of the primary impedance signal on the ascending front of its pulse wave. The method has been tested on healthy people for 10 functional tests. The results are presented characterizing dynamic peculiarities of changes of LV contractility during veloergometer exercise test with staderly increasing work load and reflecting development of positive inotropic action of sympathetic nervous system. Special characteristics of this action: small concealed period, preservation of achieved elevated level during lowering of work load (before its switching off) and subsequent slow (compared with chronotropic effect) diminution, as well as turning on at low loads. PMID:20459420

  15. Accurate segmentation framework for the left ventricle wall from cardiac cine MRI

    NASA Astrophysics Data System (ADS)

    Sliman, H.; Khalifa, F.; Elnakib, A.; Soliman, A.; Beache, G. M.; Gimel'farb, G.; Emam, A.; Elmaghraby, A.; El-Baz, A.

    2013-10-01

    We propose a novel, fast, robust, bi-directional coupled parametric deformable model to segment the left ventricle (LV) wall borders using first- and second-order visual appearance features. These features are embedded in a new stochastic external force that preserves the topology of LV wall to track the evolution of the parametric deformable models control points. To accurately estimate the marginal density of each deformable model control point, the empirical marginal grey level distributions (first-order appearance) inside and outside the boundary of the deformable model are modeled with adaptive linear combinations of discrete Gaussians (LCDG). The second order visual appearance of the LV wall is accurately modeled with a new rotationally invariant second-order Markov-Gibbs random field (MGRF). We tested the proposed segmentation approach on 15 data sets in 6 infarction patients using the Dice similarity coefficient (DSC) and the average distance (AD) between the ground truth and automated segmentation contours. Our approach achieves a mean DSC value of 0.926±0.022 and AD value of 2.16±0.60 compared to two other level set methods that achieve 0.904±0.033 and 0.885±0.02 for DSC; and 2.86±1.35 and 5.72±4.70 for AD, respectively.

  16. [Cardiac arrhythmias in hypertensive subjects with and without left ventricular hypertrophy compared to the circadian profile of the blood pressure].

    PubMed

    Novo, S; Barbagallo, M; Abrignani, M G; Alaimo, G; Longo, B; Corrao, S; Nardi, E; Liquori, M; Forte, G; Raineri, A

    1990-08-01

    To evaluate possible correlations between cardiac arrhythmias and circadian pattern of blood pressure (BP) and of heart rate (HR), we studied 2 groups of 20 males with stable arterial hypertension of mild to moderate entity, with (Group I) or without (Group II) left ventricular hypertrophy (LVH). In patients with LVH the mean age (56 vs 46 years), the duration of the hypertensive state (48.1 vs 15.7 months), the thickening of interventricular septum (IVS; 13.7 vs 9.6 mm) and of the posterior wall of the left ventricle (13.2 vs 9.2 mm) and the mass of LV (149.8 vs 99.7 g/m2) were significantly greater (p less than 0.01). On the contrary, the 2 groups did not show significant differences concerning casual BP determined in the morning (178.3/108.4 vs 171.5/106.2 mmHg). After a pharmacological washout of 2 weeks, patients underwent a noninvasive, intermittent, monitoring of BP (every 15 min during daytime and every 30 min from 11 pm to 7 am), using a pressure meter II Del Mar Avionics, and a continuous monitoring of ECG for 24 hours, employing an instrument 445/B Del Mar Avionics. Mean 24-hour BP was not different in the 2 groups of patients (161.7/99.0 vs 158.2/98.3 mmHg); however, patients with LVH showed a significantly greater variability of BP in the morning (7 am-3 pm), while mean 24-hour HR was significantly less (71.6 vs 78.2 b/min).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2150345

  17. Zic3 is required in the extra-cardiac perinodal region of the lateral plate mesoderm for left–right patterning and heart development

    PubMed Central

    Jiang, Zhengxin; Zhu, Lirong; Hu, Lingyun; Slesnick, Timothy C.; Pautler, Robia G.; Justice, Monica J.; Belmont, John W.

    2013-01-01

    Mutations in ZIC3 cause human X-linked heterotaxy and isolated cardiovascular malformations. A mouse model with targeted deletion of Zic3 demonstrates an early role for Zic3 in gastrulation, CNS, cardiac and left–right axial development. The observation of multiple malformations in Zic3null mice and the relatively broad expression pattern of Zic3 suggest its important roles in multiple developmental processes. Here, we report that Zic3 is primarily required in epiblast derivatives to affect left–right patterning and its expression in epiblast is necessary for proper transcriptional control of embryonic cardiac development. However, cardiac malformations in Zic3 deficiency occur not because Zic3 is intrinsically required in the heart but rather because it functions early in the establishment of left–right body axis. In addition, we provide evidence supporting a role for Zic3 specifically in the perinodal region of the posterior lateral plate mesoderm for the establishment of laterality. These data delineate the spatial requirement of Zic3 during left–right patterning in the mammalian embryo, and provide basis for further understanding the molecular mechanisms underlying the complex interaction of Zic3 with signaling pathways involved in the early establishment of laterality. PMID:23184148

  18. Zic3 is required in the extra-cardiac perinodal region of the lateral plate mesoderm for left-right patterning and heart development.

    PubMed

    Jiang, Zhengxin; Zhu, Lirong; Hu, Lingyun; Slesnick, Timothy C; Pautler, Robia G; Justice, Monica J; Belmont, John W

    2013-03-01

    Mutations in ZIC3 cause human X-linked heterotaxy and isolated cardiovascular malformations. A mouse model with targeted deletion of Zic3 demonstrates an early role for Zic3 in gastrulation, CNS, cardiac and left-right axial development. The observation of multiple malformations in Zic3(null) mice and the relatively broad expression pattern of Zic3 suggest its important roles in multiple developmental processes. Here, we report that Zic3 is primarily required in epiblast derivatives to affect left-right patterning and its expression in epiblast is necessary for proper transcriptional control of embryonic cardiac development. However, cardiac malformations in Zic3 deficiency occur not because Zic3 is intrinsically required in the heart but rather because it functions early in the establishment of left-right body axis. In addition, we provide evidence supporting a role for Zic3 specifically in the perinodal region of the posterior lateral plate mesoderm for the establishment of laterality. These data delineate the spatial requirement of Zic3 during left-right patterning in the mammalian embryo, and provide basis for further understanding the molecular mechanisms underlying the complex interaction of Zic3 with signaling pathways involved in the early establishment of laterality. PMID:23184148

  19. Cardiac chamber volumes by echocardiography using a new mathematical method: A promising technique for zero-G use

    NASA Technical Reports Server (NTRS)

    Buckey, J. C.; Beattie, J. M.; Gaffney, F. A.; Nixon, J. V.; Blomqvist, C. G.

    1984-01-01

    Accurate, reproducible, and non-invasive means for ventricular volume determination are needed for evaluating cardiovascular function zero-gravity. Current echocardiographic methods, particularly for the right ventricle, suffer from a large standard error. A new mathematical approach, recently described by Watanabe et al., was tested on 1 normal formalin-fixed human hearts suspended in a mineral oil bath. Volumes are estimated from multiple two-dimensional echocardiographic views recorded from a single point at sequential angles. The product of sectional cavity area and center of mass for each view summed over the range of angles (using a trapezoidal rule) gives volume. Multiple (8-14) short axis right ventricle and left ventricle views at 5.0 deg intervals were videotaped. The images were digitized by two independent observers (leading-edge to leading-edge technique) and analyzed using a graphics tablet and microcomputer. Actual volumes were determined by filling the chambers with water. These data were compared to the mean of the two echo measurements.

  20. The long-term influence of repetitive cellular cardiac rejections on left ventricular longitudinal myocardial deformation in heart transplant recipients.

    PubMed

    Clemmensen, Tor Skibsted; Løgstrup, Brian Bridal; Eiskjaer, Hans; Høyer, Søren; Poulsen, Steen Hvitfeldt

    2015-04-01

    The aim of the study was to evaluate the long-term influence of repeated acute cellular rejections on left ventricular longitudinal deformation in heart transplantation (HTX) patients. One hundred and seventy-eight HTX patients were included in the study. Rejections were classified according to the International Society of Heart and Lung Transplantation (ISHLT) classification (0R-3R). Patients were divided into three groups according to rejection scores (RSs). Group 1: <50% of biopsies with 1R rejection and no ?2R rejections; Group 2: ?50% of biopsies with 1R rejection or one biopsy with ?2R rejection; Group 3: ?Two biopsies with ?2R rejections. All patients had a comprehensive echocardiographic examination and coronary angiography. We found significantly decreasing global longitudinal strain (GLS) comparing to rejection groups (GLS group 1: -16.8 ± 2.4 (%); GLS group 2: -15.9 ± 3.3 (%); GLS group 3: -14.5 ± 2.9 (%), P = 0.0003). After excluding patients with LVEF < 50% or vasculopathy, GLS was still significantly reduced according to RS groups (P = 0.0096). Total number of 1R and 2R rejections correlated significant to GLS in a linear regression model. In contrast, we found fractional shortening and LVEF to be unaffected by repeated rejections. In conclusion, repeated cardiac rejections lead to impaired graft function as detected by decreasing magnitude of GLS. In contrast, traditional systolic graft function surveillance by LVEF did not correlate to rejection burden. PMID:25581105

  1. An Inverse Finite Element Method for Determining the Tissue Compressibility of Human Left Ventricular Wall during the Cardiac Cycle

    PubMed Central

    Hassaballah, Abdallah I.; Hassan, Mohsen A.; Mardi, Azizi N.; Hamdi, Mohd

    2013-01-01

    The determination of the myocardium’s tissue properties is important in constructing functional finite element (FE) models of the human heart. To obtain accurate properties especially for functional modeling of a heart, tissue properties have to be determined in vivo. At present, there are only few in vivo methods that can be applied to characterize the internal myocardium tissue mechanics. This work introduced and evaluated an FE inverse method to determine the myocardial tissue compressibility. Specifically, it combined an inverse FE method with the experimentally-measured left ventricular (LV) internal cavity pressure and volume versus time curves. Results indicated that the FE inverse method showed good correlation between LV repolarization and the variations in the myocardium tissue bulk modulus K (K?=?1/compressibility), as well as provided an ability to describe in vivo human myocardium material behavior. The myocardium bulk modulus can be effectively used as a diagnostic tool of the heart ejection fraction. The model developed is proved to be robust and efficient. It offers a new perspective and means to the study of living-myocardium tissue properties, as it shows the variation of the bulk modulus throughout the cardiac cycle. PMID:24367544

  2. Extended fetal echocardiographic examination for detecting cardiac malformations in low risk pregnancies

    Microsoft Academic Search

    R. Achiron; J. Glaser; I. Gelernter; J. Hegesh; S. Yagel

    1992-01-01

    OBJECTIVE--To improve the rate of prenatal detection of cardiac malformations in a low risk population. DESIGN--Comparison of extended fetal echocardiography with the standard four chamber view in detecting abnormalities. Extended echocardiography comprised the four chamber view and visualisation of the left ventricular outflow tract, the right ventricular outflow tract, and the main pulmonary artery and its branches. In cases with

  3. [The effect of an intracardiac left-right shunt on thermodilution measurements of cardiac output. An extracorporeal circulation model].

    PubMed

    Weyland, A; Wietasch, G; Hoeft, A; Buhre, W; Allgeier, B; Weyland, W; Kettler, D

    1995-01-01

    Thermodilution measurements of cardiac output (CO) by means of Swan-Ganz catheters, in a strict sense, represent pulmonary arterial blood flow (PBF). In principle, this is also true in the presence of intracardiac left-to-right shunts due to atrial or ventricular septal defects. However, early recirculation of indicator may give rise to serious methodological problems in these cases. We sought to determine the influence of intracardiac left-to-right shunts on different devices for thermodilution measurements of CO using an extra-corporeal flow model. METHODS. Blood flow was regulated by means of a centrifugal pump that at the same time enabled complete mixing of the indicator after injection (Fig. 1). Pulmonary and systemic parts of the circulation were simulated using two membrane oxygenators and a systemic-venous reservoir to delay systemic recirculation of indicator. Control measurements of PBF (Qp) and systemic (Qs) blood flow were performed by calibrated electromagnetic flow-meters (EMF). Blood temperature was kept constant using a heat exchanger without altering the indicator mass balance in the pulmonary circulation. Left-to-right shunt was varied at different systemic flow levels applying a Qp:Qs ratio ranging from 1:1 to 2.5:1. Thermodilution measurements of PBF were performed using two different thermodilution catheters that were connected to commercially available CO computers. Additionally, thermodilution curves were recorded on a microcomputer and analysed with custom-made software that enabled iterative regression analyses of the initial decay to determine that part of the downslope that best fits a mono-exponentially declining function. Extrapolation of the thermodilution curve was then based on the respective curve segment in order to eliminate indicator recirculation due to shunt flow. RESULTS. At moderate left-to-right shunts (Qp:Qs < 2:1) all thermodilution measurements showed close agreement with control measurements. At higher shunt flows (Qp:Qs > or = 2:1), however, conventional extrapolation procedures of CO computers considerably underestimated PBF (Fig. 2). This was particularly true when a slow-response thermistor catheter was used (Fig. 3). The reason for this underestimation of Qp was an overestimation of the area under curve because of inadequate mathematical elimination of indicator recirculation by standard truncation methods (Fig. 4). However, curve-alert messages of the commercially implemented software did not occur. A high level of agreement could be consistently obtained using a fast-response thermistor together with individual definition of extrapolation limits according to logarithmic regression analyses. DISCUSSION AND CONCLUSION. Under varying levels of left-to-right shunt, both the response time of thermodilution catheters and the algorithms for calculation of flow considerably influenced the validity of thermodilution measurements of PBF in an extracorporeal flow model. The use of computer-based regression analyses to define the optimal segment for monoexponential extrapolation could effectively eliminate indicator recirculation from the initial portion of the declining thermodilution curve and showed the closest agreement with EMF measurements of Qp. The quality of thermodilution curves with respect to recirculation peaks in the flow model was slightly better than in clinical routine. Nevertheless, the clinical applicability of the modified extrapolation algorithm could be illustrated during pulmonary thermodilution measurements in an exemplary patient with a ventricular septal defect (Fig. 5). PBF at extremely high shunt ratios, however, cannot be assessed by monoexponential extrapolation in principle (Fig. 6). Insufficient elimination of indicator recirculation resulted in flow values that closely resembled systemic rather than PBF. This finding is in accordance with a mathematical analysis of the underlying Steward-Hamilton equation if an infinite number of recirculations would be PMID:7695076

  4. Recurrent myxoma implanted in the left atrial appendage.

    PubMed

    Roldán, F J; Vargas-Barrón, J; Espinola-Zavaleta, N; Keirns, C; Romero-Cárdenas, A

    2000-02-01

    We present the case of a young woman who developed myxomas in multiple cardiac chambers for the third time. One of the tumors was found in the left atrial appendage with the use of transesophageal echocardiography, indicating that this technique is the method of choice for the follow-up of multiple myxomas. PMID:10978976

  5. Videoscopic Left Cardiac Sympathetic Denervation for Patients With Recurrent Ventricular Fibrillation/Malignant Ventricular Arrhythmia Syndromes Besides Congenital Long-QT Syndrome

    PubMed Central

    Coleman, Mira A.; Bos, J. Martijn; Johnson, Jonathan N.; Owen, Heidi J.; Deschamps, Claude; Moir, Christopher; Ackerman, Michael J.

    2014-01-01

    Background Treatment options for patients with recurrent ventricular arrhythmias refractory to pharmacotherapy and ablation are minimal. Although left cardiac sympathetic denervation (LCSD) is well established in long-QT syndrome, its role in non-long-QT syndrome arrhythmogenic channelopathies and cardiomyopathies is less clear. Here, we report our single-center experience in performing LCSD in this setting. Methods and Results In this institutional review board-approved study, we retrospectively reviewed the electronic medical records of all patients (N=91) who had videoscopic LCSD at our institution from 2005 to 2011. Data were analyzed for the subset (n=27) who were denervated for an underlying diagnosis other than autosomal dominant or sporadic long-QT syndrome. The spectrum of arrhythmogenic disease included catecholaminergic polymorphic ventricular tachycardia (n=13), Jervell and Lange-Nielsen syndrome (n=5), idiopathic ventricular fibrillation (n=4), left ventricular noncompaction (n=2), hypertrophic cardiomyopathy (n=1), ischemic cardiomyopathy (n=1), and arrhythmogenic right ventricular cardiomyopathy (n=1). Five patients had LCSD because of high-risk assessment and ?-blocker intolerance, none of whom had a sentinel breakthrough cardiac event at early follow-up. Among the remaining 22 previously symptomatic patients who had LCSD as secondary prevention, all had an attenuation in cardiac events, with 18 having no breakthrough cardiac events so far and 4 having experienced ?1 post-LCSD breakthrough cardiac event. Conclusions LCSD may represent a substrate-independent antifibrillatory treatment option for patients with life-threatening ventricular arrhythmia syndromes other than long-QT syndrome. The early follow-up seems promising, with a marked reduction in the frequency of cardiac events postdenervation. PMID:22787014

  6. Commonalities of cardiac rupture (left ventricular free wall or ventricular septum or papillary muscle) during acute myocardial infarction secondary to atherosclerotic coronary artery disease.

    PubMed

    Roberts, William C; Burks, Kendall H; Ko, Jong Mi; Filardo, Giovanni; Guileyardo, Joseph M

    2015-01-01

    Although mortality rates during acute myocardial infarction (AMI) continue to drop, cardiac rupture (left ventricular free wall [LVFW] or ventricular septum [VS] or papillary muscle [PM] or combination) remains relatively common. The aim was to identify commonalities among patients with AMI complicated by cardiac rupture. During a 22-year period (1993-2014) 64 patients hospitalized for AMI were studied and clinical and morphologic variables in those with (25 patients) - vs - those without (39 patients) cardiac rupture were compared, and previous reports on this topic were reviewed. Compared to the non-rupture cases, the rupture group was significantly older (71 years - vs - 60 years); had a much higher frequency of huge deposits of adipose tissue in the heart (floated in formaldehyde) (88% - vs - 20%) but a lower mean body mass index (28.2 Kg/m(2) - vs - 33.2 Kg/m(2)); a much lower frequency of healed myocardial infarct (scar) (4% - vs - 28%); a lower frequency of diabetes mellitus (24% - vs - 47%), and a higher frequency of thrombolytic therapy during the fatal AMI (32% - vs - 10%). None of the rupture cases had evidence of dilated left ventricular cavities or evidence of heart failure before the AMI complicated by rupture. In conclusion, cardiac rupture appears to account for a high percent of deaths during a first AMI. It most commonly occurs in patients with extremely fatty hearts and in those without evidence of prior heart failure. PMID:25456862

  7. Evaluation of Cardiac Function Index as Measured by Transpulmonary Thermodilution as an Indicator of Left Ventricular Ejection Fraction in Cardiogenic Shock

    PubMed Central

    Perny, Jessica; Perez, Pierre; Levy, Bruno

    2014-01-01

    Introduction. The PiCCO transpulmonary thermodilution technique provides two indices of cardiac systolic function, the cardiac function index (CFI) and the global ejection fraction (GEF). Both appear to be correlated with left ventricular ejection fraction (LVEF) measured by echocardiography in patients with circulatory failure, especially in septic shock. The aim of the present study was to test the reliability of CFI as an indicator of LVEF in patients with cardiogenic shock. Methods. In thirty-five patients with cardiogenic shock, we performed (i) simultaneous measurements of echocardiography LVEF and cardiac function index assessed by transpulmonary thermodilution (n = 72) and (ii) transpulmonary thermodilution before/after increasing inotropic agents (n = 18). Results. Mean LVEF was 31% (+/?11.7), CFI 3/min (+/?1), and GEF 14.2% (+/?6). CFI and GEF were both positively correlated with LVEF (P < 0.0001, r2 = 0.27). CFI and GEF were significantly increased with inotropic infusion (resp., P = 0.005, P = 0.007). A cardiac function index <3.47/min predicted a left ventricular ejection fraction ?35% (sensitivity 81.1% and specificity 63%). In patients with right ventricular dysfunction, CFI was not correlated with LVEF. Conclusion. CFI is correlated with LVEF provided that patient does not present severe right ventricular dysfunction. Thus, the PiCCO transpulmonary thermodilution technique is useful for the monitoring of inotropic therapy during cardiogenic shock. PMID:25013790

  8. Hydrogen sulfide suppresses the expression of MMP-8, MMP-13, and TIMP-1 in left ventricles of rats with cardiac volume overload

    PubMed Central

    Zhang, Chao-ying; Li, Xiao-hui; Zhang, Ting; Fu, Jin; Cui, Xiao-dai

    2013-01-01

    Aim: To study the effects of hydrogen sulfide (H2S) on the left ventricular expression of MMP-8, MMP-13, and TIMP-1 in a rat model of congenital heart disease. Methods: Male SD rats underwent abdominal aorta-inferior vena cava shunt operation. H2S donor NaHS (56 ?mol·kg?1·d?1, ip) was injected from the next day for 8 weeks. At 8 weeks, the hemodynamic parameters, including the left ventricular systolic pressure (LVSP), the left ventricular peak rate of contraction and relaxation (LV±dp/dtmax) and the left ventricular end diastolic pressure (LVEDP) were measured. The left ventricular tissues were dissected out, and hydroxyproline and collagen I contents were detected with ELISA. The expression of MMP-8, MMP-13, and a tissue inhibitor of metalloproteinase-1 (TIMP-1) in the tissues was measured using real-time PCR, Western blotting, and immunohistochemistry, respectively. Results: The shunt operation markedly reduced LVSP and LV±dp/dtmax, increased LVEDP, hydroxyproline and collagen I contents, as well as the mRNA and protein levels of MMP-8, MMP-13, and TIMP-1 in the left ventricles. Chronic treatment of the shunt operation rats with NaHS effectively prevented the abnormalities in the hemodynamic parameters, hydroxyproline and collagen I contents, and the mRNA and protein levels of MMP-13 and TIMP-1 in the left ventricles. NaHS also prevented the increase of MMP-8 protein expression, but did not affect the increase of mRNA level of MMP-8 in the shunt operation rats. Conclusion: H2S suppresses protein and mRNA expression of MMP-8, MMP-13, and TIMP-1 in rats with cardiac volume overload, which may be contributed to the amelioration of ventricular structural remodeling and cardiac function. PMID:23974514

  9. Characterization of Suitability of Coronary Venous Anatomy for Targeting Left Ventricular Lead Placement in Patients Undergoing Cardiac Resynchronization Therapy

    PubMed Central

    Yaminisharif, Ahmad; Davoodi, Gholamreza; Kazemisaeid, Ali; Sadeghian, Saeed; Farahani, Ali Vasheghani; Yazdanifard, Parin; Sheikhvatan, Mehrdad; Shafiee, Akbar

    2012-01-01

    Background: Differences in the quantity and distribution of coronary veins between patients with ischemic and nonischemic cardiomyopathy might affect the potential for the left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy (CRT). In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. Methods: This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. Results: There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group (48.4% versus 32.1%, p value = 0.049). There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery (CABG) had significantly fewer suitable veins in the posterolateral position than did the non-CABG group (16.3% versus 38.7%, p value = 0.029). There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. Conclusion: The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT. PMID:23074628

  10. Left ventricular mass and hypertrophy by echocardiography and cardiac magnetic resonance: The Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Armstrong, Anderson C.; Gjesdal, Ola; Almeida, André; Nacif, Marcelo; Wu, Colin; Bluemke, David A.; Brumback, Lyndia; Lima, João A. C.

    2013-01-01

    BACKGROUND Left ventricular mass (LVM) and hypertrophy (LVH) are important parameters, but their use is surrounded by controversies. We compare LVM by echocardiography and cardiac magnetic resonance (CMR), investigating reproducibility aspects and the effect of echocardiography image quality. We also compare indexing methods within and between imaging modalities for classification of LVH and cardiovascular risk. METHODS MESA enrolled 880 participants in Baltimore City; 146 had echocardiograms and CMR on the same day. LVM was then assessed using standard techniques. Echocardiography image quality was rated (good/limited) according to the parasternal view. LVH was defined after indexing LVM to body surface area, height1.7, height2.7, or by the predicted LVM from a reference group. Participants were classified for cardiovascular risk according to Framingham score. Pearson’s correlation, Bland-Altman plots, percent agreement, and kappa coefficient assessed agreement within and between modalities. RESULTS LVM by echocardiography (140 ± 40 g) and by CMR were correlated (r = 0.8, p < 0.001) regardless of the echocardiography image quality. The reproducibility profile had strong correlations and agreement for both modalities. Image quality groups had similar characteristics; those with good images compared to CMR slightly superiorly. The prevalence of LVH tended to be higher with higher cardiovascular risk. The agreement for LVH between imaging modalities ranged from 77% to 98% and the kappa coefficient from 0.10 to 0.76. CONCLUSIONS Echocardiography has a reliable performance for LVM assessment and classification of LVH, with limited influence of image quality. Echocardiography and CMR differ in the assessment of LVH, and additional differences rise from the indexing methods. PMID:23930739

  11. Controlled and Cardiac-Restricted Overexpression of the Arginine Vasopressin V1A Receptor Causes Reversible Left Ventricular Dysfunction Through G?q-Mediated Cell Signaling

    PubMed Central

    Li, Xue; Chan, Tung O.; Myers, Valerie; Chowdhury, Ibrul; Zhang, Xue-Qian; Song, Jianliang; Zhang, Jin; Andrel, Jocelyn; Funakoshi, Hajime; Robbins, Jeffrey; Koch, Walter J.; Hyslop, Terry; Cheung, Joseph Y.; Feldman, Arthur M.

    2013-01-01

    Background [Arg8]-vasopressin (AVP) activates 3 G-protein coupled receptors: V1A, V2 and V1B. The AVP-V2 receptor is the primary AVP receptor in the heart; however, its role in cardiac homeostasis is controversial. To better understand AVP-mediated signaling in the heart, we created a transgenic mouse with controlled over-expression of the V1A receptor. Methods and Results The V1A receptor transgene was placed under the control of the tetracycline-regulated, cardiac-specific alpha-myosin heavy chain promoter (V1A-TG). V1A-TG mice had a normal cardiac function phenotype at 10 weeks of age. However, by 24 weeks of age, tTA/V1A-TG mouse hearts had reduced cardiac function, cardiac hypertrophy and dilatation of the ventricular cavity. Contractile dysfunction was also observed in isolated adult cardiac myocytes. When V1A receptor transgene was induced to express in adult mice (V1A-TGInd), left ventricular dysfunction and dilation were also seen, albeit at a later time point. Since V1A receptor mediates cell signaling through G?q protein, we blocked G?q signaling by crossing tTA/V1A mice with transgenic mice that expressed a small inhibitory peptide against G?q (Gq-I inhibitor peptide). G?q blockade abrogated the development of the heart failure phenotype in tTA/V1A TG mice. The heart failure phenotype could be reversed by administration of doxycyline. Conclusion Our results demonstrate a role for V1A-mediated signaling in the development of heart failure and support a role for V1A blockade in the treatment of patients with elevated levels of vasopressin. PMID:21747049

  12. Do X-ray determined cardiac volume and signs of congestive heart failure provide additional prognostic information after myocardial infarction if the left ventricular ejection fraction is known?

    PubMed

    Rollag, A; Mangschau, A; Jonsbu, J; Aase, O; Nerdrum, H J; Erikssen, J

    1989-04-01

    Cardiac volume (CV) was measured and indices of pulmonary congestion (PCG) were judged from routine chest films taken post myocardial infarction (AMI) in a consecutive series of 477 patients (340 first and 137 recurrent AMIs). Cardiac volume (CV) and signs of PCG were compared to left ventricular ejection fraction (LVEF), measured with isotope technique, and the prognostic value of all the parameters was assessed after 1 and 5 years. The accuracy of CV and PCG in predicting impaired LVEF was low (62% and 50% respectively). Although specificity is suboptimal, however, these parameters provided valuable prognostic information. For example, patients with signs of PCG had a very high 1 and 5 years' mortality, and two-thirds of those who died during the first year of observation had enlarged CV. The independent value of LVEF determination was mainly observed in re-AMI patients. A more restricted use of this expensive procedure may therefore be recommended. PMID:2498456

  13. Multiaxial tomography of heart chambers by gated blood-pool emission computed tomography using a rotating gamma camera

    SciTech Connect

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

    1983-05-01

    Fifteen patients and three volunteers underwent radionuclide blood-pool cardiac studies with electrocardiographic gating. Following conventional planar-gated imaging (anterior and left anterior oblique projections), emission computed tomography (ECT), using a rotating gamma camera, was performed.A series of transaxial tomograms of the cardiac chambers was obtained. The left ventricular short-axis plane, long-axis plane, and four-chamber-view plane were then reorganized; each chamber was visualized separately. Compared to gated planar imaging, this technique showed regional asynergy more clearly in patients with myocardial infarction and demonstrated dilatation of the atria and ventricles more accurately in patients with an atrial septal defect and valvular heart diseases. In addition, when a section of the heart is otained at any angle with gated blood pool ECT, three-dimensional assessment of cardiac chambers in motion is more precise; mutual superimposition becomes unnecessary.

  14. Left ventricular global longitudinal systolic strain predicts adverse remodeling and subsequent cardiac events in patients with acute myocardial infarction treated with primary percutaneous coronary intervention.

    PubMed

    Lacalzada, Juan; de la Rosa, Alejandro; Izquierdo, María Manuela; Jiménez, Juan José; Iribarren, José Luis; García-González, Martín Jesús; López, Belén Marí; Duque, María Amelia; Barragán, Antonio; Hernández, Celestino; Carrillo-Pérez, María; Laynez, Ignacio

    2015-03-01

    To determine whether left ventricular (LV) global longitudinal strain (GLS) predicts adverse LV remodeling and cardiac events. In a prospective cohort study of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), we recorded clinical data and GLS, global circumferential strain and radial strain using two-dimensional speckle-tracking echocardiography of the left ventricle. At 6-month and 3-year follow-ups, patients were grouped by presence or absence of adverse LV remodeling. We used logistic regression to identify factors associated with adverse LV remodeling and a Cox model to determine the relationships between these factors and cardiac events. Of 97 patients (mean age 56 ± 12 years; 76 men), 38 showed LV remodeling. Diabetes mellitus [odds ratio (OR) 1.95 % confidence interval (CI) 1.2-4.8, p = 0.05], peak troponin I (OR 1.2, 95 % CI 1.1-1.3, p = 0.004), and GLS (OR 1.6, 95 % CI 1.3-2.3, p = 0.009) independently predicted LV remodeling. During follow-up (22.8 ± 12.3 months), 20 patients suffered adverse events, which were independently predicted by GLS alone (OR 4.9, 95 % CI 1.7-13.9, p = 0.002). Optimal GLS cutoffs for predicting adverse LV remodeling and cardiac events were >-12.46 % [area under receiver operating-characteristic curve (AUC) 0.88, 95 % CI 0.79-0.96, p < 0.001] and >-9.27 % (AUC 0.86, 95 % CI 0.64-0.98, p < 0.001), respectively. GLS measured immediately after primary PCI is an excellent predictor of adverse LV remodeling and cardiac events in patients with AMI. PMID:25596940

  15. Construction of a two-parameter empirical model of left ventricle wall motion using cardiac tagged magnetic resonance imaging data

    E-print Network

    Shi, Jack J; Alenezy, Mohammed D.; Smirnova, Irina V.; Bilgen, Mehmet

    2012-10-24

    visualized using cardiac tagged magnetic resonance imaging (tMRI) covering the contraction and relaxation phases. Based on the characteristics of the overall dynamics of the LV wall, its motion was represented by a combination of two components - radial...

  16. Treatment with a copper-selective chelator causes substantive improvement in cardiac function of diabetic rats with left-ventricular impairment

    PubMed Central

    2013-01-01

    Background Defective copper regulation is implicated as a causative mechanism of organ damage in diabetes. Treatment with trientine, a divalent-copper-selective chelator, improves arterial and renal structure/function in diabetes, wherein it also ameliorates left-ventricular (LV) hypertrophy. However, direct in vivo evidence that trientine can improve cardiac function in heart failure has hitherto been lacking. Methods To determine whether trientine treatment could improve in vivo outcome, we measured cardiac function in groups of trientine-treated diabetic (TETA-DIA), non-drug-treated diabetic (DIA) and sham-treated control (SHAM) rats, by using in vivo high-field cardiac magnetic-resonance imaging (cMRI) and an ex vivo isolated-perfused working heart method. Forty age-matched animals underwent a cMRI scan after which 12 were randomized to the SHAM group and 28 underwent streptozotocin-injection; of these, 25 developed stable diabetes, and 12 were then randomized to receive no treatment for 16 weeks (DIA) and the other 13 to undergo 8-weeks’ untreated diabetes followed by 8-weeks’ drug treatment (TETA-DIA). Animals were studied again by cMRI at 8 and 16 weeks following disease induction, and finally by measurement of ex vivo cardiac function. Results After eight weeks diabetes, rats (DIA/TETA-DIA) had developed significant impairment of LV function, as judged by impairment of ejection fraction (LVEF), cardiac output (CO), and LV mass (LVM)/body-mass (all P?cardiac function by elevating LVEF and CO (both P?cardiac function in diabetic rats with substantive LV impairment. These results implicate impaired copper regulation in the pathogenesis of impaired cardiac function caused by diabetic cardiomyopathy, and support ongoing studies of trientine treatment in patients with heart failure. PMID:23368770

  17. A Comprehensive Analysis of Cardiac Dose in Balloon-Based High-Dose-Rate Brachytherapy for Left-Sided Breast Cancer

    SciTech Connect

    Valakh, Vladimir, E-mail: vladimir@valakh.com [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Kim, Yongbok; Werts, E. Day; Trombetta, Mark G. [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Drexel University College of Medicine, Allegheny Campus, Pittsburgh, PA (United States)

    2012-04-01

    Purpose: To investigate radiation dose to the heart in 60 patients with left-sided breast cancer who were treated with balloon-based high-dose-rate brachytherapy using MammoSite or Contura applicators. Methods and Materials: We studied 60 consecutive women with breast cancer who were treated with 34 Gy in 10 twice-daily fractions using MammoSite (n = 37) or Contura (n = 23) applicators. The whole heart and the left and right ventricles were retrospectively delineated, and dose-volume histograms were analyzed. Multiple dosimetrics were reported, such as mean dose (D{sub mean}); relative volume receiving 1.7, 5, 10, and 20 Gy (V1.7, V5, V10, and V20, respectively); dose to 1 cc (D{sub 1cc}); and maximum point dose (D{sub max}). Biologic metrics, biologically effective dose and generalized equivalent uniform dose were computed. The impact of lumpectomy cavity location on cardiac dose was investigated. Results: The average {+-} standard deviation of D{sub mean} was 2.45 {+-} 0.94 Gy (range, 0.56-4.68) and 3.29 {+-} 1.28 Gy (range, 0.77-6.35) for the heart and the ventricles, respectively. The average whole heart V5 and V10 values were 10.2% and 1.3%, respectively, and the heart D{sub max} was >20 Gy in 7 of 60 (11.7%) patients and >25 Gy in 3 of 60 (5%) patients. No cardiac tissue received {>=}30 Gy. The V1.7, V5, V10, V20, and D{sub mean} values were all higher for the ventricles than for the whole heart. For balloons located in the upper inner quadrant of the breast, the average whole heart D{sub mean} was highest. The D{sub mean}, biologically effective dose, and generalized equivalent uniform dose values for heart and ventricles decreased with increasing minimal distance from the surface of the balloon. Conclusions: On the basis of these comprehensive cardiac dosimetric data, we recommend that cardiac dose be routinely reported and kept as low as possible in balloon-based high-dose-rate brachytherapy treatment planning for patients with left-sided breast cancer so the correlation with future cardiac toxicity data can be investigated.

  18. Geometric and Dosimetric Approach to Determine Probability of Late Cardiac Mortality in Left Tangential Breast Irradiation: Comparison Between Wedged Beams and Field-in-Field Technique

    SciTech Connect

    Pili, Giorgio; Grimaldi, Luca; Fidanza, Christian; Florio, Elena T. [Department of Medical Physics, 'A. Perrino' Hospital, Brindisi (Italy); Petruzzelli, Maria F. [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); D'Errico, Maria P. [Department of Laboratory Medicine, 'A. Perrino' Hospital, Brindisi (Italy); De Tommaso, Cristina; Tramacere, Francesco [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); Musaio, Francesca [Department of Medical Physics, 'A. Perrino' Hospital, Brindisi (Italy); Castagna, Roberta; Francavilla, Maria C. [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); Gianicolo, Emilio A.L. [National Research Council-Clinical Physiology Institute, Pisa-Lecce (Italy); Portaluri, Maurizio, E-mail: portaluri@hotmail.com [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); National Research Council-Clinical Physiology Institute, Pisa-Lecce (Italy)

    2011-11-01

    Purpose: To evaluate the probability of late cardiac mortality resulting from left breast irradiation planned with tangential fields and to compare this probability between the wedged beam and field-in-field (FIF) techniques and to investigate whether some geometric/dosimetric indicators can be determined to estimate the cardiac mortality probability before treatment begins. Methods and Materials: For 30 patients, differential dose-volume histograms were calculated for the wedged beam and FIF plans, and the corresponding cardiac mortality probabilities were determined using the relative seriality model. As a comparative index of the dose distribution uniformity, the planning target volume (PTV) percentages involved in 97-103% of prescribed dose were determined for the two techniques. Three geometric parameters were measured for each patient: the maximal length, indicates how much the heart contours were displaced toward the PTV, the angle subtended at the center of the computed tomography slice by the PTV contour, and the thorax width/thickness ratio. Results: Evaluating the differential dose-volume histograms showed that the gain in uniformity between the two techniques was about 1.5. With the FIF technique, the mean dose sparing for the heart, the left anterior descending coronary artery, and the lung was 15% (2.5 Gy vs. 2.2 Gy), 21% (11.3 Gy vs. 9.0 Gy), and 42% (8.0 Gy vs. 4.6 Gy) respectively, compared with the wedged beam technique. Also, the cardiac mortality probability decreased by 40% (from 0.9% to 0.5%). Three geometric parameters, the maximal length, angle subtended at the center of the computed tomography slice by the PTV contour, and thorax width/thickness ratio, were the determining factors (p = .06 for FIF, and p = .10 for wedged beam) for evaluating the cardiac mortality probability. Conclusion: The FIF technique seemed to yield a lower cardiac mortality probability than the conventional wedged beam technique. However, although our study demonstrated that FIF technique improved the dose coverage of the PTV, the restricted number of patients enrolled and the short follow-up did not allow us to evaluate and compare the breast cancer survival rates of the patients.

  19. [Complete occlusion of the left main coronary artery complicated by cardiac arrest and acute massive pulmonary embolism with a favourable outcome--a case report].

    PubMed

    Mar?, Mi?osz; Kurianowicz, Rafa?; Wa?czura, Piotr; Bak, Janusz; Rudnicki, Zbigniew; Olszewski, Miros?aw; Weglarz, Maciej

    2006-02-01

    A case of a 53-year-old male with acute myocardial infarction complicated by cardiac arrest is presented. Due to neurological complications which were transient, the patient was not selected for primary angioplasty. Three days later his condition significantly improved and the patient was transferred to internal ward were he developed cardiogenic shock due to a massive pulmonary embolism. Thrombolysis and low molecular weight heparin were effective and the patient did well during subsequent hospitalisation period. Coronary angiography was performed 4 weeks from hospital admission and revealed a total left main coronary occlusion with good collateral circulation from the right coronary artery. Finally, the patient underwent successful CABG. PMID:16502371

  20. Left Ventricle: Fully Automated Segmentation Based on Spatiotemporal Continuity and Myocardium Information in Cine Cardiac Magnetic Resonance Imaging (LV-FAST)

    PubMed Central

    Wang, Lijia; Pei, Mengchao; Codella, Noel C. F.; Kochar, Minisha; Weinsaft, Jonathan W.; Li, Jianqi; Prince, Martin R.

    2015-01-01

    CMR quantification of LV chamber volumes typically and manually defines the basal-most LV, which adds processing time and user-dependence. This study developed an LV segmentation method that is fully automated based on the spatiotemporal continuity of the LV (LV-FAST). An iteratively decreasing threshold region growing approach was used first from the midventricle to the apex, until the LV area and shape discontinued, and then from midventricle to the base, until less than 50% of the myocardium circumference was observable. Region growth was constrained by LV spatiotemporal continuity to improve robustness of apical and basal segmentations. The LV-FAST method was compared with manual tracing on cardiac cine MRI data of 45 consecutive patients. Of the 45 patients, LV-FAST and manual selection identified the same apical slices at both ED and ES and the same basal slices at both ED and ES in 38, 38, 38, and 41 cases, respectively, and their measurements agreed within ?1.6 ± 8.7?mL, ?1.4 ± 7.8?mL, and 1.0 ± 5.8% for EDV, ESV, and EF, respectively. LV-FAST allowed LV volume-time course quantitatively measured within 3 seconds on a standard desktop computer, which is fast and accurate for processing the cine volumetric cardiac MRI data, and enables LV filling course quantification over the cardiac cycle. PMID:25738153

  1. A novel cardiac muscle-derived biomaterial reduces dyskinesia and postinfarct left ventricular remodeling in a mouse model of myocardial infarction

    PubMed Central

    O'Connor, Daniel M; Naresh, Nivedita K; Piras, Bryan A; Xu, Yaqin; Smith, Robert S; Epstein, Frederick H; Hossack, John A; Ogle, Roy C; French, Brent A

    2015-01-01

    Extracellular matrix (ECM) degradation after myocardial infarction (MI) leaves the myocardium structurally weakened and, as a result, susceptible to early infarct zone dyskinesia and left ventricular (LV) remodeling. While various cellular and biomaterial preparations have been transplanted into the infarct zone in hopes of improving post-MI LV remodeling, an allogeneic cardiac muscle-derived ECM extract has yet to be developed and tested in the setting of reperfused MI. We sought to determine the effects of injecting a novel cardiac muscle-derived ECM into the infarct zone on early dyskinesia and LV remodeling in a mouse model of MI. Cardiac muscle ECM was extracted from frozen mouse heart tissue by a protocol that enriches for basement membrane constituents. The extract was injected into the infarct zone immediately after ischemia/reperfusion injury (n = 6). Echocardiography was performed at baseline and at days 2, 7, 14, and 28 post-MI to assess 3D LV volumes and cardiac function, as compared to infarcted controls (n = 9). Early infarct zone dyskinesia was measured on day 2 post-MI using a novel metric, the dyskinesia index. End-systolic volume was significantly reduced in the ECM-treated group compared to controls by day 14. Ejection fraction and stroke volume were also significantly improved in the ECM-treated group. ECM-treated hearts showed a significant (P < 0.005) reduction in dyskinetic motion on day 2. Thus, using high-frequency ultrasound, it was shown that treatment with a cardiac-derived ECM preparation reduced early infarct zone dyskinesia and post-MI LV remodeling in a mouse model of reperfused MI. PMID:25825543

  2. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: A novel cardiac syndrome mimicking acute myocardial infarction

    Microsoft Academic Search

    Satoshi Kurisu; Hikaru Sato; Takuji Kawagoe; Masaharu Ishihara; Yuji Shimatani; Kenji Nishioka; Yasuyuki Kono; Takashi Umemura; Suji Nakamura

    2002-01-01

    Background Peculiar asynergy, which consists of hypokinesis or akinesis from the mid portion to the apical area and hyperkinesis of the basal area on contrast left ventriculogram, is rare. Because the end-systolic left ventriculogram looks like a “tako-tsubo,” which was used for trapping octopuses in Japan, we proposed the term “tako-tsubo-like left ventricular dysfunction.” Our aim was to evaluate its

  3. Minimally invasive implantation of an extracorporeal membrane oxygenation circuit used as a temporary left ventricular assist device: a new concept for bridging to permanent cardiac support.

    PubMed

    Saito, Shunsuke; Fleischer, Bernhard; Maeß, Christoph; Baraki, Hassina; Kutschka, Ingo

    2015-03-01

    The implantation of cardiac assist devices is associated with poor outcome in patients with multiple organ failure and unknown neurologic status. Therefore, temporary left ventricular assist devices (LVAD) using, for example, extracorporeal centrifugal pumps may provide the chance to further evaluate the patient's clinical course and a potential qualification for implantable LVAD therapy. On the other hand, a main disadvantage of the temporary LVAD implantation is the need for redo surgery, increasing the risk of the final LVAD Implantation. To minimize this drawback of the temporary LVAD implantation, we implanted the temporary LVAD using a minimally invasive technique. The operation was done without cardiopulmonary bypass support, and the temporary LVAD was implanted through upper hemisternotomy and left anterior mini-thoracotomy. The patient recovered from multiple organ failure and was successfully bridged to a permanent LVAD therapy. PMID:25370719

  4. Relationship between changes of chamber mechanical parameters and mean pressure-mean flow diagrams of the left ventricle.

    PubMed

    Negroni, J A; Lascano, E C; Pichel, R H

    1988-01-01

    A theoretical relationship between mean ventricular pressure (P) and mean ventricular outflow (Q) was developed based on a model of the left ventricle with elastic-resistive properties. Using a polynomial interpolation method, a fifth-order polynomial equation for the P-Q relationship was obtained. Its coefficients are functions of end-diastolic volume (VD), heart rate (HR), contractile state (CS), diastolic elastance (ED), asymmetry (S) of the elastance function E(t), and ventricular internal resistance factor (K). Effect of changes of these parameters indicated that normal and enhanced CS relations diverge toward the P axis but have a common intercept toward the Q axis. A similar effect was obtained with increased asymmetry of E(t). Changes in VD, HR and ED produced a parallel shift of the P-Q relation. The effect of K was negligible, however, which would reduce the description of the P-Q relationship to a third-order polynomial equation. A flow-dependent deactivation component was introduced, altering the asymmetry factor S, which decreases in a linear proportion to Q. This factor shifted the pump function graph downwards. We conclude that the theoretical description of the P-Q relation we present reproduces the experimental behavior of pump function diagrams reported in the literature (changes in VD, HR, and CS) and predicts the possible behavior due to other parameter changes. PMID:3400909

  5. Double inlet left ventricle

    MedlinePLUS

    ... born with this condition have only one working pumping chamber (ventricle) in their heart. ... condition generally have a large left ventricle (the pumping chamber of the heart that supplies the body ...

  6. Integration of nodal and BMP signals in the heart requires FoxH1 to create left-right differences in cell migration rates that direct cardiac asymmetry.

    PubMed

    Lenhart, Kari F; Holtzman, Nathalia G; Williams, Jessica R; Burdine, Rebecca D

    2013-01-01

    Failure to properly establish the left-right (L/R) axis is a major cause of congenital heart defects in humans, but how L/R patterning of the embryo leads to asymmetric cardiac morphogenesis is still unclear. We find that asymmetric Nodal signaling on the left and Bmp signaling act in parallel to establish zebrafish cardiac laterality by modulating cell migration velocities across the L/R axis. Moreover, we demonstrate that Nodal plays the crucial role in generating asymmetry in the heart and that Bmp signaling via Bmp4 is dispensable in the presence of asymmetric Nodal signaling. In addition, we identify a previously unappreciated role for the Nodal-transcription factor FoxH1 in mediating cell responsiveness to Bmp, further linking the control of these two pathways in the heart. The interplay between these TGF? pathways is complex, with Nodal signaling potentially acting to limit the response to Bmp pathway activation and the dosage of Bmp signals being critical to limit migration rates. These findings have implications for understanding the complex genetic interactions that lead to congenital heart disease in humans. PMID:23358434

  7. Impact of the bifurcation angle on major cardiac events after cross-over single stent strategy in unprotected left main bifurcation lesions: 3-dimensional quantitative coronary angiographic analysis

    PubMed Central

    Amemiya, Kisaki; Domei, Takenori; Iwabuchi, Masashi; Shirai, Shinichi; Ando, Kenji; Goya, Masahiko; Yokoi, Hiroyoshi; Nobuyoshi, Masakiyo

    2014-01-01

    The impact of the bifurcation angle (BA) between the left main (LM) and the main branch on clinical outcomes after single stenting has never been documented. Therefore, the aim of this study was to investigate the impact of the BA on clinical outcomes after single cross-over LM to left anterior descending artery (LAD) stenting. A total of 170 patients who underwent percutaneous coronary intervention (PCI) in unprotected LM bifurcation with successful single cross-over stenting from the LM into the LAD were enrolled. The main vessel angle between the LM and the LAD was computed in end-diastole before PCI with three-dimensional (3D) quantitative coronary angiography (QCA) software. The patients were classified into three groups according to tertiles of the main vessel angle. The cumulative incidence of major adverse cardiac event (MACE: cardiac death, myocardial infarction, any revascularization including target lesion revascularization) rates throughout a 12-month period were compared between the three groups. Baseline patient characteristics were not a significant difference between the three groups. Compared to the high angle group, the low angle group had a significantly higher incidence of MACE (p = 0.041). In conclusion, this study revealed that low BA between the LM and the LAD had an adverse clinical impact after single cross-over LM to LAD stenting. PMID:25628958

  8. The number of cardiac myocytes in the hypertrophic and hypotrophic left ventricle of the obese and calorie-restricted mouse heart.

    PubMed

    Schipke, Julia; Banmann, Ewgenija; Nikam, Sandeep; Voswinckel, Robert; Kohlstedt, Karin; Loot, Annemarieke E; Fleming, Ingrid; Mühlfeld, Christian

    2014-11-01

    Changes in body mass due to varying amounts of calorie intake occur frequently with obesity and anorexia/cachexia being at opposite sides of the scale. Here, we tested whether a high-fat diet or calorie restriction (CR) decreases the number of cardiac myocytes and affects their volume. Ten 6-8-week-old mice were randomly assigned to a normal (control group, n?=?5) or high-fat diet (obesity group, n?=?5) for 28?weeks. Ten 8-week-old mice were randomly assigned to a normal (control group, n?=?5) or CR diet (CR group, n?=?5) for 7?days. The left ventricles of the hearts were prepared for light and electron microscopy, and analysed by design-based stereology. In CR, neither the number of cardiac myocytes, the relationship between one- and multinucleate myocytes nor their mean volume were significantly different between the groups. In contrast, in the obese mice we observed a significant increase in cell size combined with a lower number of cardiomyocytes (P?cardiac myocyte reflected the hypertrophic and hypotrophic remodelling in obesity and CR, respectively, but were only significant in the obese mice, indicating a more profound effect of the obesity protocol than in the CR experiments. Taken together, our data indicate that long-lasting obesity is associated with a loss of cardiomyocytes of the left ventricle, but that short-term CR does not alter the number of cardiomyocytes. PMID:25322944

  9. Acute severe cardiac failure complicating myocardial infarction. Experience with 100 patients referred for consideration of mechanical left ventricular assistance

    Microsoft Academic Search

    M F ORourke; V P Chang; H M Windsor; M X Shanahan; J B Hickie; J J Morgan; J F Gunning; A W Seldon; G V Hall; G Michell; D Goldfarb; D G Harrision

    1975-01-01

    One hundred patients were referred with suspected acute cardiac failure following acute myocardial infarction. The diagnosis was confirmed in 72: 31 of these patients underwent elective medical treatment, with 2 survivors (6%); 41 were accepted for counter pulsation, but 9 died before this could be initiated and another 2 died shortly after vain attempts to pass the balloon catheter were

  10. Autosomal dominant inheritance of cardiac valves anomalies in two families: extended spectrum of left-ventricular outflow tract obstruction

    Microsoft Academic Search

    Marja W. Wessels; Ingrid M. B. H. van de Laar; Jolien Roos-Hesselink; Sipke Strikwerda; Danielle F. Majoor-Krakauer; L. B. A. de Vries; Wilhelmina S. Kerstjens-Frederikse; Yvonne J. Vos; Bianca M. de Graaf; Aida M. Bertoli-Avella; Patrick J. Willems

    2009-01-01

    Only a limited number of families with clear monogenic inheritance of nonsyndromic forms of congenital valve defects have been described. We describe two multiplex pedigrees with a similar nonsyndromic form of heart valve anomalies that segregate as an autosomal dominant condition. The first family is a three-generation pedigree with 10 family members affected with congenital defects of the cardiac valves,

  11. Hemodynamic changes during left ventricular assist device-off test correlate with the degree of cardiac fibrosis and predict the outcome after device explantation.

    PubMed

    Saito, Shunsuke; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Sakata, Yasushi; Mizote, Isamu; Daimon, Takashi; Sawa, Yoshiki

    2015-03-01

    Myocardial recovery occurs in a small cohort of patients receiving left ventricular assist device (LVAD) support, but identification of candidates for device removal remains challenging. We hypothesized that hemodynamic evaluation using echocardiography and right heart catheter during temporary suspension of LVAD support (LVAD-off test) can assess cardiac recovery to predict successful device removal. To prove this hypothesis, we reviewed 44 patients who underwent LVAD-off test from January 2000 to March 2011 at Osaka University Hospital. Twenty-two of them underwent LVAD explant, 9 showed sustaining recovery (successful explant, SE-group); whereas 13 had a recurrent heart failure (failed explant, FE-group). The other 22 patients remained LVAD dependent (nonrecovery, NR-group). Echocardiography showed significant lower ejection fraction (LVEF) in NR-group than in SE- and FE-group after termination of LVAD support, but there was no difference between SE- and FE-group. On the other hand, elevation in pulmonary capillary wedge pressure (?PCWP) was significantly smaller in SE-group than in FE- and NR-groups. The degree of cardiac fibrosis significantly increased in FE- and NR-group during the LVAD support, while it did not increase in SE-group. The degree of cardiac fibrosis at the time of LVAD explantation correlated significantly with PCWP at LVAD halt and ?PCWP, and it had significant impact on the outcome after LVAD weaning. In conclusion, the data obtained during LVAD-off test using echocardiography and right heart catheter significantly correlated with the degree of cardiac fibrosis at the time of LVAD explantation. LVAD-off test is a useful method to predict the successful LVAD explantation. PMID:25370718

  12. Comparison of Echocardiographic Markers of Cardiac Dyssynchrony and Latest Left Ventricular Activation Site in Heart Failure Patients with and without Left Bundle Branch Block

    PubMed Central

    Lotfi-Tokaldany, Masoumeh; Roomi, Zahra Savand; Kasemisaeid, Ali; Sadeghian, Hakimeh

    2013-01-01

    Background: Several echocardiographic markers have been introduced to assess the left ventricular (LV) mechanical dyssynchrony. We studied dyssynchrony markers and the latest LV activation site in heart failure patients with and without left bundle branch block (LBBB). Methods: Conventional echocardiography and tissue velocity imaging were performed for 78 patients (LV ejection fraction ? 35%), who were divided into two groups: LBBB (n = 37) and non-LBBB (n = 41). Time-to-peak systolic velocity (Ts) was measured in 12 LV segments in the mid and basal levels. Seven dyssynchrony markers were defined: delay and standard deviation (SD) of Ts in all and basal segments, septal-lateral and anteroseptal-posterior wall delay (at the basal level), and interventricular mechanical delay (IVMD). Results: The LBBB patients had significantly higher QRS duration and IVMD. The posterior wall was the latest activated site in the LBBB and the inferior wall was the latest in the non-LBBB patients. The most common dyssynchrony marker in the LBBB group was the SD of Ts in all segments (73%), whereas it was Ts delay in the basal segments in the non-LBBB group (48.8%). Ts delay and SD of all LV segments, septal lateral delay, septal-to-posterior wall delay by M-mode, pre-ejection period of the aortic valve, and IVMD were significantly higher in the LBBB group than in the non-LBBB group. Also, 29.3% of the non-LBBB and 10.8% of the LBBB patients did not show dyssynchrony by any marker. The number of patients showing dyssynchrony by ? 3 markers was remarkably higher in the LBBB patients (73% vs. 43.9%, respectively; p value = 0.044). Conclusion: The LBBB patients presented with a higher prevalence of dyssynchrony according to the frequently used echocardiographic markers. The latest activation site was different between the groups. PMID:23967031

  13. Combined score using clinical, electrocardiographic, and echocardiographic parameters to predict left ventricular remodeling in patients having had cardiac resynchronization therapy six months earlier.

    PubMed

    Brunet-Bernard, Anne; Maréchaux, Sylvestre; Fauchier, Laurent; Guiot, Aurélie; Fournet, Maxime; Reynaud, Amélie; Schnell, Frédéric; Leclercq, Christophe; Mabo, Philippe; Donal, Erwan

    2014-06-15

    The aim of this study was to evaluate whether a scoring system integrating clinical, electrocardiographic, and echocardiographic measurements can predict left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). The derivation cohort consisted of 162 patients with heart failure implanted with a CRT device. Baseline clinical, electrocardiographic, and echocardiographic characteristics were entered into univariate and multivariate models to predict reverse remodeling as defined by a ?15% reduction in left ventricular end-systolic volume at 6 months (60%). Combinations of predictors were then tested under different scoring systems. A new 7-point CRT response score termed L2ANDS2: Left bundle branch block (2 points), Age >70 years, Nonischemic origin, left ventricular end-diastolic Diameter <40 mm/m(2), and Septal flash (2 points) was calculated for these patients. This score was then validated against a validation cohort of 45 patients from another academic center. A highly significant incremental predictive value was noted when septal flash was added to an initial 4-factor model including left bundle branch block (difference between area under the curve C statistics = 0.125, p <0.001). The predictive accuracy using the L2ANDS2 score was then 0.79 for the C statistic. Application of the new score to the validation cohort (71% of responders) gave a similar C statistic (0.75). A score >5 had a high positive likelihood ratio (+LR = 5.64), whereas a score <2 had a high negative likelihood ratio (-LR = 0.19). In conclusion, this L2ANDS2 score provides an easy-to-use tool for the clinician to assess the pretest probability of a patient being a CRT responder. PMID:24793667

  14. N-Terminal Pro-B-Type Natriuretic Peptide Plasma Levels as a Potential Biomarker for Cardiac Damage After Radiotherapy in Patients With Left-Sided Breast Cancer

    SciTech Connect

    D'Errico, Maria P., E-mail: patderrico@libero.it [Department of Laboratory Medicine, 'A. Perrino' Hospital, Brindisi (Italy); Grimaldi, Luca [Department of Medical Physics, 'A. Perrino' Hospital, Brindisi (Italy); Petruzzelli, Maria F. [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); Gianicolo, Emilio A.L. [Clinical Physiology Institute, National Research Council (IFC-CNR), Pisa-Lecce (Italy); Tramacere, Francesco [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); Monetti, Antonio; Placella, Roberto [Department of Laboratory Medicine, 'A. Perrino' Hospital, Brindisi (Italy); Pili, Giorgio [Department of Medical Physics, 'A. Perrino' Hospital, Brindisi (Italy); Andreassi, Maria Grazia; Sicari, Rosa; Picano, Eugenio [Clinical Physiology Institute, National Research Council (IFC-CNR), Pisa-Lecce (Italy); Portaluri, Maurizio [Department of Radiation Oncology, 'A. Perrino' Hospital, Brindisi (Italy); Clinical Physiology Institute, National Research Council (IFC-CNR), Pisa-Lecce (Italy)

    2012-02-01

    Purpose: Adjuvant radiotherapy (RT) after breast-conserving surgery has been associated with increased cardiovascular mortality. Cardiac biomarkers may aid in identifying patients with radiation-mediated cardiac dysfunction. We evaluated the correlation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin (TnI) and the dose of radiation to the heart in patients with left-sided breast cancer. Methods and Materials: NT-proBNP and TnI plasma concentrations were measured in 30 left-sided breast cancer patients (median age, 55.0 years) 5 to 22 months after RT (Group I) and in 30 left-sided breast cancer patients (median age, 57.0 years) before RT as control group (Group II). Dosimetric and geometric parameters of heart and left ventricle were determined in all patients of Group I. Seventeen patients underwent complete two-dimensional echocardiography. Results: NT-proBNP levels were significantly higher (p = 0.03) in Group I (median, 90.0 pg/ml; range, 16.7-333.1 pg/ml) than in Group II (median, 63.2 pg/ml; range, 11.0-172.5 pg/ml). TnI levels remained below the cutoff threshold of 0.07 ng/ml in both groups. In patients with NT-proBNP values above the upper limit of 125 pg/ml, there were significant correlations between plasma levels and V{sub 3Gy}(%) (p = 0.001), the ratios D{sub 15cm{sup 3}}(Gy)/D{sub mean}(Gy) (p = 0.01), the ratios D{sub 15cm}{sup 3}/D{sub 50%} (Gy) (p = 0.008) for the heart and correlations between plasma levels and V{sub 2Gy} (%) (p = 0.002), the ratios D{sub 1cm{sup 3}}(Gy)/D{sub mean}(Gy) (p = 0.03), and the ratios D{sub 0.5cm{sup 3}}(Gy)/D{sub 50%}(Gy) (p = 0.05) for the ventricle. Conclusions: Patients with left-sided breast cancer show higher values of NT-pro BNP after RT when compared with non-RT-treated matched patients, increasing in correlation with high doses in small volumes of heart and ventricle. The findings of this study show that the most important parameters are not the mean doses but instead the small percentage of organ volumes (heart or ventricle) receiving high dose levels, supporting the notion that the heart behaves as a serial organ.

  15. Novel Left Ventricular Assist System®

    PubMed Central

    Liotta, Domingo

    2003-01-01

    We propose a Novel Left Ventricular Assist System® (Novel LVAS®) as a bridge to cardiac transplantation and to functional heart recovery in advanced heart failure. This report regards the principles that led to its development. It is our hope that the design of a high-peak-output pump of smaller size will lead to improved functional capacity, when compared with currently available left ventricular assist bridges to heart recovery. Several basic considerations went into the design of this system: 1) we did not want to cannulate the heart chambers; 2) in particular, we rejected the use of a left ventricular apical cannula for myocardial recovery, because it destroys the helical anatomy of the chamber; 3) we chose an atriostomy for blood inflow to the implanted pump; and 4) we synchronized the pump to the patient's electrocardiogram, to ensure blood pump ejection in diastole. The key to success is the atriostomy, which creates an opening larger than the patient's mitral valve. The atriostomy may be performed with the heart beating. Bleeding from the left ventricular apical anastomosis is a fairly common occurrence in currently available left ventricular assist systems; subsequent transfusion can exacerbate right heart dysfunction and sensitize the immune system. These complications are avoided with our system. The new system works either in partial mode or total mode, depending on whether partial or full left ventricular unloading is required. The Novel Left Ventricular Assist System is in its initial clinical trial stage, under the supervision of the author. (Tex Heart Inst J 2003;30:194–201) PMID:12959201

  16. Global left ventricular function in cardiac CT. Evaluation of an automated 3D region-growing segmentation algorithm

    Microsoft Academic Search

    Georg Mühlenbruch; Marco Das; Christian Hohl; Joachim E. Wildberger; Daniel Rinck; Thomas G. Flohr; Ralf Koos; Christian Knackstedt; Rolf W. Günther; Andreas H. Mahnken

    2006-01-01

    The purpose was to evaluate a new semi-automated 3D region-growing segmentation algorithm for functional analysis of the left\\u000a ventricle in multislice CT (MSCT) of the heart. Twenty patients underwent contrast-enhanced MSCT of the heart (collimation\\u000a 16?0.75 mm; 120 kV; 550 mAseff). Multiphase image reconstructions with 1-mm axial slices and 8-mm short-axis slices were performed.\\u000a Left ventricular volume measurements (end-diastolic volume, end-systolic volume, ejection

  17. Body surface potential mapping investigating the ventricular activation patterns in the cardiac resynchronization of patients with left bundle-branch block and heart failure.

    PubMed

    Pastore, Carlos Alberto; Tobias, Nancy; Samesima, Nelson; Filho, Martino Martinelli; Pedrosa, Anisio; Nishioka, Silvana; Douglas, Roberto A; Moreira, Luís Felipe; Ramires, José Franchini

    2006-01-01

    Body surface potential mapping assessed mean cardiac electrical activation times displayed by isochronal maps in the right ventricle (RV; right ventricle mean activation time [mRV]), anterior septal area (anterior septal area mean activation time [mAS]), and left ventricle (left ventricle mean activation time [mLV]) of 28 patients (mean, 61.07 years; congestive heart failure class III-IV; ejection fraction, < or =40%; left bundle-branch block [LBBB] QRS, 180.17 milliseconds), before and after biventricular pacemaker implantation, comparing them, using reference values from a control group of healthy individuals with normal hearts (GNL), in (1) baseline native LBBB, where mRV and mAS values were similar (40.99 vs 43.62 milliseconds), with mLV delayed (80.99 milliseconds, P < .01) and dyssynchronous with RV/anterior septal area; (2) single-site RV pacing, where mRV was greater than in GNL (86.82 milliseconds, P < .001), with greater mAS/mLV difference (63.41 vs 102.7 milliseconds; P < .001); and (3) biventricular pacing (BIV-PM), where mLV and mRV were similar (71.99 vs 71.58 milliseconds), mRV was greater than in GNL and native LBBB (71.58 vs 35.1 and 40.99 milliseconds; P < .001), and mAS approached values in GNL and native LBBB (51.28 vs 50.14 and 43.62 milliseconds). Body surface potential mapping showed that similar RV/left ventricle activation times during biventricular pacing, nearing mAS, indicate synchronized ventricular activation pattern in patients with congestive heart failure/LBBB. PMID:16387060

  18. Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy

    Microsoft Academic Search

    Cheuk-Man Yu; Wing-Hong Fung; Hong Lin; Qing Zhang; John E Sanderson; Chu-Pak Lau

    2003-01-01

    Biventricular pacing results in left ventricular (LV) reverse remodeling in heart failure patients with wide QRS complexes. This study examines potential predictors of reverse remodeling. Echocardiography with tissue Doppler imaging was performed at baseline and 3 months after biventricular pacing in 30 patients (21 men and 9 women, mean age 62 ± 14 years). There were 17 responders to reverse

  19. The cardiac renin-angiotensin system is responsible for high salt diet-induced left ventricular hypertrophy in mice

    E-print Network

    Paris-Sud XI, Université de

    hypertrophy in mice Philippe Le Corvoisier 1-4 , Christophe Adamy 1 , Lucien Sambin 1 , Bertrand Crozatier 5 (HS) diet-induced left ventricular hypertrophy (LVH). Methods and Results: Swiss mice were subjected hypertrophy; Blood pressure; Renin angiotensin system; Mitogen-activated protein kinases; Mice inserm-00538568

  20. Comparison of different segmentation approaches without using gold standard. Application to the estimation of the left ventricle ejection fraction from cardiac cine MRI sequences

    PubMed Central

    Lebenberg, Jessica; Buvat, Irène; Garreau, Mireille; Casta, Christopher; Constantinidès, Constantin; Cousty, Jean; Cochet, Alexandre; Jehan-Besson, Stéphanie; Tilmant, Christophe; Lefort, Muriel; Roullot, Elodie; Najman, Laurent; Sarry, Laurent; Clarysse, Patrick; De Cesare, Alain; Lalande, Alain; Frouin, Frédérique

    2011-01-01

    A statistical method is proposed to compare several estimates of a relevant clinical parameter when no gold standard is available. The method is illustrated by considering the left ventricle ejection fraction derived from cardiac magnetic resonance images and computed using seven approaches with different degrees of automation. The proposed method did not use any a priori regarding with the reliability of each method and its degree of automation. The results showed that the most accurate estimates of the ejection fraction were obtained using manual segmentations, followed by the semi-automatic methods, while the methods with the least user input yielded the least accurate ejection fraction estimates. These results were consistent with the expected performance of the estimation methods, suggesting that the proposed statistical approach might be helpful to assess the performance of estimation methods on clinical data for which no gold standard is available. PMID:22254889

  1. Normal left ventricular myocardial thickness for middle aged and older subjects with SSFP cardiac MR: The Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Kawel, Nadine; Turkbey, Evrim B.; Carr, J. Jeffrey; Eng, John; Gomes, Antoinette S.; Hundley, W. Gregory; Johnson, Craig; Masri, Sofia C.; Prince, Martin R.; van der Geest, Rob J.; Lima, João A. C.; Bluemke, David A.

    2012-01-01

    Background Increased left ventricular myocardial thickness (LVMT) is a feature of several cardiac diseases. The purpose of this study was to establish standard reference values of normal LVMT with cardiac MR (CMR) and to assess variation with image acquisition plane, demographics and LV function. Methods and Results End-diastolic LVMT was measured on CMR steady-state free precession cine long and short axis images in 300 consecutive participants free of cardiac disease (169 women; 65.6±8.5 years) of the Multi-Ethnic Study of Atherosclerosis cohort. Mean LVMT on short axis images at the mid-cavity level was 5.3±0.9mm and 6.3±1.1mm for women and men, respectively. The average of the maximum LVMT at the mid-cavity for women/men were 7mm/9mm (long axis) and 7mm/8mm (short axis). Mean LVMT was positively associated with weight (0.02mm/kg, p=0.01) and body-surface-area (1.1mm/m2, p<0.001). No relationship was found between mean LVMT and age or height. Greater mean LVMT was associated with lower LV end-diastolic volume (0.01mm/ml, p<0.01), a lower LV end-systolic volume (?0.01mm/ml, p=0.01) and lower LV stroke volume (?0.01mm/ml, p<0.05). LVMT measured on long axis images at the basal and mid-cavity level were slightly greater (by 6% and 10%, respectively) than measurements obtained on short axis images; apical LVMT values on long axis images were 20% less than those on short axis images. Conclusion Normal values for wall thickness are provided for middle-aged and older subjects. Normal LVMT is lower for women than men. Observed values vary depending on the imaging plane for measurement. PMID:22705587

  2. Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs.

    PubMed

    Xu, Da; Olivier, N Bari; Mukkamala, Ramakrishna

    2009-02-01

    We developed a technique to continuously (i.e., automatically) monitor cardiac output (CO) and left atrial pressure (LAP) by mathematical analysis of the pulmonary artery pressure (PAP) waveform. The technique is unique to the few previous related techniques in that it jointly estimates the two hemodynamic variables and analyzes the PAP waveform over time scales greater than a cardiac cycle wherein wave reflections and inertial effects cease to be major factors. First, a 6-min PAP waveform segment is analyzed so as to determine the pure exponential decay and equilibrium pressure that would eventually result if cardiac activity suddenly ceased (i.e., after the confounding wave reflections and inertial effects vanish). Then, the time constant of this exponential decay is computed and assumed to be proportional to the average pulmonary arterial resistance according to a Windkessel model, while the equilibrium pressure is regarded as average LAP. Finally, average proportional CO is determined similar to invoking Ohm's law and readily calibrated with one thermodilution measurement. To evaluate the technique, we performed experiments in five dogs in which the PAP waveform and accurate, but highly invasive, aortic flow probe CO and LAP catheter measurements were simultaneously recorded during common hemodynamic interventions. Our results showed overall calibrated CO and absolute LAP root-mean-squared errors of 15.2% and 1.7 mmHg, respectively. For comparison, the root-mean-squared error of classic end-diastolic PAP estimates of LAP was 4.7 mmHg. On future successful human testing, the technique may potentially be employed for continuous hemodynamic monitoring in critically ill patients with pulmonary artery catheters. PMID:19057003

  3. Empiric versus imaging guided left ventricular lead placement in cardiac resynchronization therapy (ImagingCRT): study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Cardiac resynchronization therapy (CRT) is an established treatment in heart failure patients. However, a large proportion of patients remain nonresponsive to this pacing strategy. Left ventricular (LV) lead position is one of the main determinants of response to CRT. This study aims to clarify whether multimodality imaging guided LV lead placement improves clinical outcome after CRT. Methods/Design The ImagingCRT study is a prospective, randomized, patient- and assessor-blinded, two-armed trial. The study is designed to investigate the effect of imaging guided left ventricular lead positioning on a clinical composite primary endpoint comprising all-cause mortality, hospitalization for heart failure, or unchanged or worsened functional capacity (no improvement in New York Heart Association class and <10% improvement in six-minute-walk test). Imaging guided LV lead positioning is targeted to the latest activated non-scarred myocardial region by speckle tracking echocardiography, single-photon emission computed tomography, and cardiac computed tomography. Secondary endpoints include changes in LV dimensions, ejection fraction and dyssynchrony. A total of 192 patients are included in the study. Discussion Despite tremendous advances in knowledge with CRT, the proportion of patients not responding to this treatment has remained stable since the introduction of CRT. ImagingCRT is a prospective, randomized study assessing the clinical and echocardiographic effect of multimodality imaging guided LV lead placement in CRT. The results are expected to make an important contribution in the pursuit of increasing response rate to CRT. Trial registration Clinicaltrials.gov identifier NCT01323686. The trial was registered March 25, 2011 and the first study subject was randomized April 11, 2011. PMID:23782792

  4. Association of the Frontal QRS-T Angle with Adverse Cardiac Remodeling, Impaired Left and Right Ventricular Function, and Worse Outcomes in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Selvaraj, Senthil; Ilkhanoff, Leonard; Burke, Michael A.; Freed, Benjamin H.; Lang, Roberto M.; Martinez, Eva E.; Shah, Sanjiv J.

    2013-01-01

    Background No prior studies have investigated the association of QRS-T angle with cardiac structure/function and outcomes in heart failure with preserved ejection fraction (HFpEF). We hypothesized that increased frontal QRS-T angle is associated with worse cardiac function/remodeling and adverse outcomes in HFpEF. Methods We prospectively studied 376 patients with HFpEF (i.e. symptomatic HF with left ventricular [LV] ejection fraction >50%.) The frontal QRS-T angle was calculated from the 12-lead electrocardiogram. Patients were divided into tertiles by frontal QRS-T angle (0–26°, 27–75°, and 76–179°), and clinical, laboratory, and echocardiographic data were compared among groups. Cox proportional hazards analyses were performed to determine the association between QRS-T angle and outcomes. Results The mean age of the cohort was 64±13 years, 65% were women, and the mean QRS-T angle was 61±51°. Patients with increased QRS-T angle were older, had a lower body-mass index, more frequently had coronary artery disease, diabetes, chronic kidney disease, and atrial fibrillation, and had higher B-type natriuretic peptide (BNP) levels (P<0.05 for all comparisons). After multivariable adjustment, patients with increased QRS-T angle had higher BNP levels in addition to higher LV mass index, worse diastolic function parameters, more right ventricular (RV) remodeling, and worse RV systolic function (P<0.05 for all associations). QRS-T angle was independently associated with the composite outcome of cardiovascular hospitalization or death on multivariable analysis, even after adjusting for BNP (HR for the highest QRS-T tertile = 2.0, 95% CI 1.2–3.4; P=0.008). Conclusions In HFpEF, increased QRS-T angle is independently associated with worse left and right ventricular function/remodeling and adverse outcomes. PMID:24075945

  5. The relation of red blood cell fatty acids with vascular stiffness, cardiac structure and left ventricular function: The Framingham Heart Study.

    PubMed

    Kaess, Bernhard M; Harris, William S; Lacey, Sean; Larson, Martin G; Hamburg, Naomi M; Vita, Joseph A; Robins, Sander J; Benjamin, Emelia J; Mitchell, Gary F; Vasan, Ramachandran S

    2015-02-01

    Polyunsaturated fatty acids have been associated with beneficial influences on cardiovascular health. However, the underlying mechanisms are not clear, and data on the relations of polyunsaturated fatty acids to subclinical disease measures such as vascular stiffness and cardiac function are sparse and inconclusive. In a large community-based cohort, we examined the relations of omega-3 and other fatty acids to a comprehensive panel of vascular function measures (assessing microvascular function and large artery stiffness), cardiac structure and left ventricular function. Red blood cell (RBC) membrane fatty acid composition, a measure of long-term fatty acid intake, was assessed in participants of the Framingham Offspring Study and Omni cohorts and related to tonometry-derived measures of vascular stiffness and to a panel of echocardiographic traits using partial correlations. Up to n=3055 individuals (56% women, mean age 66 years) were available for analyses. In age- and sex-adjusted models, higher RBC omega-3 content was moderately associated (p?0.002) with several measures of vascular stiffness and function in a protective direction. However, after multivariable adjustment, only an association of higher RBC omega-3 content with lower carotid-femoral pulse wave velocity (a measure of aortic stiffness) remained significant (r = -0.06, p=0.002). In secondary analyses, higher linoleic acid, the major nutritional omega-6 fatty acid, was associated with smaller left atrial size, even after multivariable adjustment (r = -0.064, p<0.001). In conclusion, in our cross-sectional community-based study, we found several associations consistent with the notion of protective effects of omega-3 and linoleic acid. The clinical significance of these modest associations remains to be elucidated. PMID:25520318

  6. Atrioventricular delays, cardiac output and diastolic function in patients with implanted dual chamber pacing and sensing pacemakers.

    PubMed

    Akbarzadeh, F; Toufan, Mehrnoush

    2008-10-15

    The Cardiac Output (CO), Filling Time (FT) and Myocardial Performance Index (MPI) derived optimal atrioventricular delay (AVD), were compared and systolic and diastolic performance at every optimal AVD were analyzed. Thirty-two patients with implanted DDD pacemaker were investigated from implantation time to 6 months following PM implantation, in Cardiovascular Research Center of Tabriz University of Medical Sciences. The evaluation was performed during AV sequential pacing with different programmed AVDS ranged from 100 to 200 msec by steps of 20-30 msec. At every AVD, the following parameters were measured: FT, mitral VTI, ET, aortic VTI, ICT and IRT. CO and FT derived optimal AVDs were significantly different (146 +/- 37 and 126 +/- 35 msec, respectively), but their difference with MPI derived optimal AVDs was not significant (130 +/- 28 msec). ICT/ET was similar at CO, FT and MPI derived optimal AVD (0.24 +/- 0.10, 0.22 +/- 0.05 and 0.20 +/- 0.07, respectively). IRT/ET ratio was similar at CO, FT and MPI derived optimal AVDs (0.46 +/- 0.14, 0.45 +/- 0.10 and 0.42 +/- 0.10, respectively). Different methods indicate different optimal AVDs. However analysis of systolic and diastolic performance shows that different AVDs result in similar systolic or diastolic performance. At MPI optimized AVD, a high CO combined with the most advantageous conditions of both isovolumic contraction and relaxation phases is achieved. PMID:19137850

  7. Activated cranial cervical cord neurons affect left ventricular infarct size and the potential for sudden cardiac death

    PubMed Central

    Southerland, E. Marie; Gibbons, David D.; Smith, S. Brooks; Sipe, Adam; Williams, Carole Ann; Beaumont, Eric; Armour, J. Andrew; Foreman, Robert D.; Ardell, Jeffrey L.

    2012-01-01

    To evaluate whether cervical spinal neurons can influence cardiac indices and myocyte viability in the acutely ischemic heart, the hearts of anesthetized rabbits subjected to 30 min of LAD coronary arterial occlusion (CAO) were studied 3 hours after reperfusion. Control animals were compared to those exposed to pre-emptive high cervical cord stimulation (SCS; the dorsal aspect of the C1-C2 spinal cord was stimulated electrically at 50 Hz; 0.2 ms; 90% of motor threshold, starting 15 min prior to and continuing throughout CAO). Four groups of animals were so tested: 1) neuroaxis intact; 2) prior cervical vagotomy; 3) prior transection of the dorsal spinal columns at C6; and 4) following pharmacological treatment [muscarinic (atropine) or adrenergic (atenolol, prazosin or yohimbine) receptor blockade]. Infarct size (IS) was measured by tetrazolium, expressed as percentage of risk zone. C1-C2 SCS reduced acute ischemia induced IS by 43%, without changing the incidence of sudden cardiac death (SCD). While SCS-induced reduction in IS was unaffected by vagotomy, it was no longer evident following transection of C6 dorsal columns or atropinization. Beta-adrenoceptor blockade eliminated ischemia induced SCD, while alpha-receptor blockade doubled its incidence. During SCS, myocardial ischemia induced SCD was eliminated following vagotomy while remaining unaffected by atropinization. These data indicate that, in contrast to thoracic spinal neurons, i) cranial cervical spinal neurons affect both adrenergic and cholinergic motor outflows to the heart such that ii) their activation modifies ventricular infarct size and lethal arrhythmogenesis. PMID:22502863

  8. Utility of Doppler Myocardial Imaging, Cardiac Biomarkers and Clonal Immunoglobulin Genes to Assess Left Ventricular Performance and Stratify Risk Following Peripheral Blood Stem Cell Transplantation in Patients with Systemic Light Chain Amyloidosis (AL)

    PubMed Central

    Bellavia, Diego; Abraham, Roshini S.; Pellikka, Patricia A.; Dispenzieri, Angela; Burnett, John C.; Al-Zahrani, Ghormallah B.; Green, Tammy D.; Manske, Michelle K.; Gertz, Morie A.; Miller, Fletcher A.; Abraham, Theodore P.

    2011-01-01

    Cardiac dysfunction is a well-recognized complication of light chain amyloidosis (AL). Autologous stem cell transplant (auto-SCT) has emerged as a successful treatment modality for AL patients. In this study, we examined the effect of clonal immunoglobulin light chain genes (VL), which encodes the immunoglobulin light chain protein that ultimately forms amyloid, on cardiac function, in the context of auto-SCT and its impact on overall survival. Longitudinal Doppler myocardial imaging parameters along with cardiac biomarkers were used to assess for cardiac function pre and post auto-SCT. VL gene analysis revealed that V? genes, in particular V?VI, were associated with worse cardiac function parameters than V? genes. Clonal VL genes appeared to have an impact on left ventricular (LV) function post-transplant and also influenced mortality, with specific VL gene families associated with lower survival. Another key predictor of mortality in this report was change in tricuspid regurgitant flow velocity following auto-SCT. Correlations were also observed between systolic strain rate, systolic strain and VL genes associated with amyloid formation. In summary, clonal VL gene usage influences global cardiac function in AL, with patients having V?VI and V?II-III-associated amyloid more severely affected than those having V? or V?I amyloid. Pulsed wave tissue Doppler imaging along with immunoglobulin gene analysis offers novel insights into prediction of mortality and cardiac dysfunction in AL after auto-SCT. PMID:21315556

  9. Serum MMP-8: A Novel Indicator of Left Ventricular Remodeling and Cardiac Outcome in Patients after Acute Myocardial Infarction

    PubMed Central

    Fertin, Marie; Lemesle, Gilles; Turkieh, Annie; Beseme, Olivia; Chwastyniak, Maggy; Amouyel, Philippe; Bauters, Christophe; Pinet, Florence

    2013-01-01

    Objective Left ventricular (LV) remodeling following myocardial infarction (MI) is characterized by progressive alterations of structure and function, named LV remodeling. Although several risk factors such as infarct size have been identified, LV remodeling remains difficult to predict in clinical practice. Changes within the extracellular matrix, involving matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), are an integral part of left ventricular (LV) remodeling after myocardial infarction (MI). We investigated the temporal profile of circulating MMPs and TIMPs and their relations with LV remodeling at 1 year and clinical outcome at 3 years in post-MI patients. Methods This prospective multicentre study included 246 patients with a first anterior MI. Serial echocardiographic studies were performed at hospital discharge, 3 months, and 1 year after MI, and analysed at a core laboratory. LV remodeling was defined as the percent change in LV end-diastolic volume (EDV) from baseline to 1 year. Serum samples were obtained at hospital discharge, 1, 3, and 12 months. Multiplex technology was used for analysis of MMP-1, -2, -3, -8, -9, -13, and TIMP-1, -2, -3, -4 serum levels. Results Baseline levels of MMP-8 and MMP-9 were positively associated with changes in LVEDV (P?=?0.01 and 0.02, respectively). When adjusted for major baseline characteristics, MMP-8 levels remained an independent predictor LV remodeling (P?=?0.025). By univariate analysis, there were positive relations between cardiovascular death or hospitalization for heart failure during the 3-year follow-up and the baseline levels of MMP-2 (P?=?0.03), MMP-8 (P?=?0.002), and MMP-9 (P?=?0.03). By multivariate analysis, MMP-8 was the only MMP remaining significantly associated with clinical outcome (P?=?0.02). Conclusion Baseline serum MMP-8 is a significant predictor of LV remodeling and cardiovascular outcome after MI and may help to improve risk stratification. PMID:23967183

  10. Independent Predictors of Survival in Primary Systemic (AL) Amyloidosis, Including Cardiac Biomarkers and Left Ventricular Strain Imaging: An Observational Cohort Study

    PubMed Central

    Bellavia, Diego; Pellikka, Patricia A.; Al-Zahrani, Ghormallah B.; Abraham, Theodore P.; Dispenzieri, Angela; Miyazaki, Chinami; Lacy, Martha; Scott, Christopher G.; Oh, Jae K.; Miller, Fletcher A.

    2014-01-01

    Background The prognostic value of Doppler myocardial imaging, including myocardial velocity imaging, strain, and strain rate imaging, in patients with primary (AL) amyloidosis is uncertain. The aim of this longitudinal study was to identify independent predictors of survival, comparing clinical data, hematologic and cardiac biomarkers, and standard echocardiographic and Doppler myocardial imaging measures in a cohort of patients with AL amyloidosis. Methods A total of 249 consecutive patients with AL amyloidosis were prospectively enrolled. The primary end point was all-cause mortality, and during a median follow-up period of 18 months, 75 patients (30%) died. Clinical and electrocardiographic data, biomarkers (brain natriuretic peptide and cardiac troponin T) and standard echocardiographic and longitudinal systolic and diastolic Doppler myocardial imaging measurements for 16 left ventricular segments were tested as potential independent predictors of survival. Results Age (hazard ratio [HR], 1.03; P = .03), New York Heart Association class III or IV (HR, 2.47; P = .01), the presence of pleural effusion (HR, 1.79; P = .08), brain natriuretic peptide level (HR, 1.29; P = .01), ejection time (HR, 0.99; P = .13), and peak longitudinal systolic strain of the basal anteroseptal segment (HR, 1.05; P = .02) were independent predictors in the final model. Conclusions Multivariate survival analysis identified independent predictors of clinical outcome in patients with AL amyloidosis: New York Heart Association class III or IV, presence of pleural effusion, brain natriuretic peptide level > 493 pg/mL, ejection time < 273 ms, and peak longitudinal systolic basal anteroseptal strain less negative than or equal to ?7.5% defined a high-risk group of patients. PMID:20434879

  11. Pathological findings in cardiac apex removed during implantation of left ventricular assist devices (LVAD) are non-specific: 13-year-experience at a German Heart Center

    PubMed Central

    Strecker, Thomas; Rösch, Johannes; Weyand, Michael; Agaimy, Abbas

    2014-01-01

    Background and aim: Ventricular assist devices (VAD) have become an established therapy for patients with end-stage heart failure. The two main reasons for this development are the shortage of appropriate donor organs and the increasing number of patients waiting for heart transplantation (HTX). Furthermore, the enormous advances in the technical equipment and the rising clinical experience have improved the implantation technique, the durability and the long-term patient outcomes. Methods: We reviewed all cases of left ventricular assist device (LVAD) implantation at our Erlangen Heart Center during January 2000-July 2013. The main aim of this study was to analyze the underlying pathology from the cardiac apex removed during the implantation. From all patients, we created a follow-up, analyzed the pathological features with the clinical diagnoses and described the overall outcome. Results: VAD implantation was performed in 266 cases at our center in the last 13 years (2.2% of the total of 12254 cardiac surgical operations in that period). From these patients, 223 underwent LVAD or biventricular (BVAD) implantation; the remaining received a right (RVAD) implantation. The most frequent underlying clinical diagnoses were dilated (n = 84, 37.7%, DCM) or ischemic (n = 61, 27.4%, ICM) cardiomyopathy. The pathological findings in the apex biopsy were generally non-specific and showed variable interstitial myocardial fibrosis with evidence of fibre loss, fatty degeneration and variable irregular atrophy of muscle fibres, consistent with dilated and ischemic cardiomyopathies as the most frequent causes of heart failure in these patients. Only a few cases showed other specific features such as myocarditis and AL-amyloidosis. Conclusions: Pathological findings in cardiac apex removed during LVAD implantation are rather non-specific and they generally reflect the late stage or consequences of chronic myocardial damage in cases of dilated or ischemic cardiomyopathies. Variable patchy chronic inflammatory changes may be observed in cardiomyopathies as a non-specific reaction caused by myocardial fiber damage and should not lead to misinterpretation as evidence of myocarditis or revision of original diagnosis. PMID:25337196

  12. Simulation of cardiac motion on non-Newtonian, pulsating flow development in the human left anterior descending coronary artery

    NASA Astrophysics Data System (ADS)

    Theodorakakos, A.; Gavaises, M.; Andriotis, A.; Zifan, A.; Liatsis, P.; Pantos, I.; Efstathopoulos, E. P.; Katritsis, D.

    2008-09-01

    This study aimed at investigating the effect of myocardial motion on pulsating blood flow distribution of the left anterior descending coronary artery in the presence of atheromatous stenosis. The moving 3D arterial tree geometry has been obtained from conventional x-ray angiograms obtained during the heart cycle and includes a number of major branches. The geometry reconstruction model has been validated against projection data from a virtual phantom arterial tree as well as with CT-based reconstruction data for the same patient investigated. Reconstructions have been obtained for a number of temporal points while linear interpolation has been used for all intermediate instances. Blood has been considered as a non-Newtonian fluid. Results have been obtained using the same pulse for the inlet blood flow rate but with fixed arterial tree geometry as well as under steady-state conditions corresponding to the mean flow rate. Predictions indicate that myocardial motion has only a minor effect on flow distribution within the arterial tree relative to the effect of the blood pressure pulse.

  13. Degree and distribution of left ventricular hypertrophy as a determining factor for elevated natriuretic peptide levels in patients with hypertrophic cardiomyopathy: insights from cardiac magnetic resonance imaging.

    PubMed

    Park, Jeong Rang; Choi, Jin-Oh; Han, Hye Jin; Chang, Sung-A; Park, Sung-Ji; Lee, Sang-Chol; Choe, Yeon Hyeon; Park, Seung Woo; Oh, Jae K

    2012-04-01

    Whether the left ventricular (LV) mass index (LVMI) and LV volumetric parameters are associated independently with natriuretic peptide levels is unclear in hypertrophic cardiomyopathy (HCM). Therefore, we investigated which parameters have an independent relationship with N-terminal pro-B type natriuretic peptide (NT-proBNP) levels in HCM patients using echocardiography and cardiac magnetic resonance imaging (CMR). A total of 103 patients with HCM (82 men, age 53 ± 12 years) were evaluated. Echocardiographic evaluations included left atrial volume index (LAVI) and early diastolic mitral inflow E velocity to early annular Ea velocity ratio (E/Ea). LVMI, maximal wall thickness and LV volumetric parameters were measured using CMR. The median value of NT-proBNP level was 387.0 pg/ml. The mean NT-proBNP level in patients with non-apical HCM (n = 69; 36 patients with asymmetric septal hypertrophy, 11 with diffuse, and 22 with mixed type) was significantly higher than in those with apical HCM (n = 34, P < 0.001). NT-proBNP level was negatively correlated with LV end-diastolic volume (LVEDV) (r = -0.263, P = 0.007) and positively with LVMI (r = 0.225, P = 0.022) and maximal wall thickness (r = 0.495, P < 0.001). Among the echocardiographic variables, LAVI (r = 0.492, P < 0.001) and E/Ea (r = 0.432, P < 0.001) were correlated with NT-proBNP. On multivariable analysis, non-apical HCM, increased maximal wall thickness and LAVI were independently related with NT-proBNP. Severity of LV hypertrophy and diastolic parameters might be important in the elevation of NT-proBNP level in HCM. Therefore, further evaluation of these parameters in HCM might be warranted. PMID:21516440

  14. Successful rescue from cardiac arrest in a patient with postinfarction left ventricular blow-out rupture: "extra-pericardial aortic cannulation" for establishment total cardiopulmonary bypass.

    PubMed

    Ohira, Suguru; Yaku, Hitoshi; Nakajima, Shunsuke; Takahashi, Akihiko

    2014-08-01

    We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture. PMID:25179976

  15. Four chamber pacing in dilated cardiomyopathy.

    PubMed

    Cazeau, S; Ritter, P; Bakdach, S; Lazarus, A; Limousin, M; Henao, L; Mundler, O; Daubert, J C; Mugica, J

    1994-11-01

    A 54-year-old man received a four chamber pacing system for severe congestive heart failure (NYHA functional Class IV). His ECG showed a left bundle branch block (200-msec QRS duration) with 200-msec PR interval, normal QRS axis, and 90-msec interatrial interval. An acute hemodynamic study with insertion of four temporary leads was performed prior to the implant, which demonstrated a significant increase in cardiac output and decrease of pulmonary capillary wedge pressure. A permanent pacemaker was implanted based on the encouraging results of the acute study. The right chamber leads were introduced by cephalic and subclavian approaches. The left atrium was paced with a coronary sinus lead, Medtronic SP 2188-58 model. An epicardial Medtronic 5071 lead was placed on the LV free wall. The four leads were connected to a standard bipolar DDD pacemaker, Chorus 6234. The two atrial leads were connected via a Y-connector to the atrial channel of the pacemaker with a bipolar pacing configuration. The two ventricular leads were connected in a similar fashion to the ventricular channel of the device. The right chamber leads were connected to the distal poles. The left chamber leads were connected to the proximal poles of the pacemaker. Six weeks later, the patient's clinical status improved markedly with a weight loss of 17 kg and disappearance of peripheral edema. His functional class was reduced to NYHA II. Four chamber pacing is technically feasible. In patients with evidence of interventricular dyssynchrony, this original pacing mode probably provides a mechanical activation sequence closer to the natural one.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7845801

  16. [Experience of left ventricular assist device "Incor" as "bridge to recovery" implantation in patients with end stage congestive heart failure].

    PubMed

    Khubulava, G G; Ivchenko, E V; Pa?vin, A A; Kravchuk, V N; Iurchenko, D L; Ivashchenko, A I; Didenko, M V; Luk'ianov, N G; Peleshok, A S; Tsygan, N V; Liubimov, A I; Naumov, A B; Shorokhov, K H; Sukharev, A E; Kniazev, E A; Porembskaia, I A

    2011-11-01

    Left ventricular assist device "Incor" ("Berlinhear", Germany) implantation experience in patient with ischemic cardiomiopathy and severe congestive heart failure is presented. Left ventricular assist device implantation was followed by coronary artery bypass grafting simultaneously. Total assist time was 211 days. Complications developed during assisting time are shown. After Left ventricular assist device explantation three chamber pacemaker was implanted as cardiac resynchronization therapy. Left ventricular end diastolic size decreased (from 78 to 70 mm), ejection fraction increased (from 19 to 35%) during assist time. PMID:22329169

  17. Optimal atrioventricular delay at rest and during exercise in patients with dual chamber pacemakers: a non-invasive assessment by continuous wave Doppler

    Microsoft Academic Search

    D Mehta; S Gilmour; D E Ward; A J Camm

    1989-01-01

    The optimal atrioventricular delay at rest and during exercise was investigated in nine patients with heart block and implanted dual chamber pacemakers. All patients studied had normal left ventricular function and a normal sinus node rate response to exercise. Cardiac output was measured by continuous wave Doppler and was calculated as the product of stroke distance measured by Doppler at

  18. Percutaneous cardioscopy of the left ventricle in patients with myocarditis

    NASA Astrophysics Data System (ADS)

    Uchida, Yasumi; Tomaru, Takanobu; Nakamura, Fumitaka; Oshima, Tomomitsu; Fujimori, Yoshiharu; Hirose, Junichi

    1992-08-01

    The morphology and function of the cardiac chambers have been evaluated clinically using cineventriculography, computed tomography, magnetic resonance imaging, and endomyocardial biopsy. Excluding the invasive technique of biopsy where tissue is actually removed, these other non-invasive techniques reveal only indirect evidence of endocardial and subendocardial pathology and, therefore, allow the potential for misdiagnosis from insufficient data. Fiberoptic examinations, as recently demonstrated in coronary, pulmonary, and peripheral vessels, allow direct observation of pathology otherwise unobtainable. Recently, similar techniques have been applied to examine the cardiac chambers of dogs and the right heart of humans. In this study, we examine the feasibility and safety of percutaneous fiberoptic cardioscopy of the left ventricle in patients with myocarditis.

  19. Percutaneous fiber optic angioscopy of the left ventricle in patients with rheumatic valvular disease

    NASA Astrophysics Data System (ADS)

    Hirose, Junichi; Oshima, Tomomitsu; Fujimori, Yoshiharu; Uchida, Yasumi

    1993-05-01

    Recent advances in fiberoptic technology enabled us to observe percutaneously the cardiac chambers and valves. We examined left ventricular luminal and valvular changes by percutaneous fiberoptic angioscopy in patients with rheumatic valvular disease. Six patients with echocardiographic rheumatic changes in the mitral valves, underwent angioscopy during routine cardiac catheterization. The fiberscope 4.2 F in diameter, and the guiding catheter 9 F in external diameter with an inflatable balloon around the distal most tip were used for angioscopy. The left ventricular endocardial surface was diffusely white in color or white and brown in mosaic fashion. Echocardiography and angiography had low sensitivity for detecting the changes of the left ventricular luminal surface. Whitish changes which were observed by angioscopy were not related to the indices derived from echocardiography and angiography. The results indicate the possibility of percutaneous angioscopy in detecting left ventricular luminal changes in patients with rheumatic valvular disease.

  20. Cardiac-restricted overexpression or deletion of tissue inhibitor of matrix metalloproteinase-4: differential effects on left ventricular structure and function following pressure overload-induced hypertrophy.

    PubMed

    Yarbrough, William M; Baicu, Catalin; Mukherjee, Rupak; Van Laer, An; Rivers, William T; McKinney, Richard A; Prescott, Corey B; Stroud, Robert E; Freels, Parker D; Zellars, Kia N; Zile, Michael R; Spinale, Francis G

    2014-09-01

    Historically, the tissue inhibitors of matrix metalloproteinases (TIMPs) were considered monochromatic in function. However, differential TIMP profiles more recently observed with left ventricular (LV) dysfunction and matrix remodeling suggest more diverse biological roles for individual TIMPs. This study tested the hypothesis that cardiac-specific overexpression (TIMP-4OE) or deletion (knockout; TIMP-4KO) would differentially affect LV function and structure following pressure overload (LVPO). LVPO (transverse aortic constriction) was induced in mice (3.5 ± 0.1 mo of age, equal sex distribution) with TIMP-4OE (n = 38), TIMP-4KO (n = 24), as well as age/strain-matched wild type (WT, n = 25), whereby indexes of LV remodeling and function such as LV mass and ejection fraction (LVEF) were determined at 28 days following LVPO. Following LVPO, both early (7 days) and late (28 days) survival was ~25% lower in the TIMP-4KO group (P < 0.05). While LVPO increased LV mass in all groups, the relative hypertrophic response was attenuated with TIMP-4OE. With LVPO, LVEF was similar between WT and TIMP-4KO (48 ± 2% and 45 ± 3%, respectively) but was higher with TIMP-4OE (57 ± 2%, P < 0.05). With LVPO, LV myocardial collagen expression (type I, III) increased by threefold in all groups (P < 0.05), but surprisingly this response was most robust in the TIMP-4KO group. These unique findings suggest that increased myocardial TIMP-4 in the context of a LVPO stimulus may actually provide protective effects with respect to survival, LV function, and extracellular matrix (ECM) remodeling. These findings challenge the canonical belief that increased levels of specific myocardial TIMPs, such as TIMP-4 in and of themselves, contribute to adverse ECM accumulation following a pathological stimulus, such as LVPO. PMID:24993046

  1. Cardiac Health Risk Stratification System (CHRiSS): a Bayesian-based decision support system for left ventricular assist device (LVAD) therapy.

    PubMed

    Loghmanpour, Natasha A; Druzdzel, Marek J; Antaki, James F

    2014-01-01

    This study investigated the use of Bayesian Networks (BNs) for left ventricular assist device (LVAD) therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE) was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (%) for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS). As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making. PMID:25397576

  2. Cardiac Health Risk Stratification System (CHRiSS): A Bayesian-Based Decision Support System for Left Ventricular Assist Device (LVAD) Therapy

    PubMed Central

    Loghmanpour, Natasha A.; Druzdzel, Marek J.; Antaki, James F.

    2014-01-01

    This study investigated the use of Bayesian Networks (BNs) for left ventricular assist device (LVAD) therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE) was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (%) for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS). As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making. PMID:25397576

  3. High-amplitude left ventricular pacing in cardiac resynchronization therapy: an alternative way to increase response rate in non-responders

    PubMed Central

    Ak?n, Filiz; Demircan, Sabri; Soylu, Korhan; Erbay, Alir?za; Yuksel, Serkan; Meric, Murat; Gulel, Okan; Sahin, Mahmut; Y?lmaz, Ozcan

    2013-01-01

    Purpose This study compared patients who underwent cardiac resynchronization therapy (CRT) by high-amplitude left ventricular (LV) pacing with those who underwent CRT by standard LV pacing. Methods We included 32 CRT patients with ejection fraction (EF) ?35%, QRS time ?120 ms, and New York Heart Association (NYHA) class III/IV symptoms of heart failure despite optimal medical treatment. These patients were evaluated clinically and echocardiographically before, three and six months after CRT. At the 3rd month, the LV pulse amplitude value was set high at 5 volt for 16 patients [high-amplitude Group (HAG)], while for the other 16 patients, it was reduced to at least twice the threshold value at ?2.5 volt [low-amplitude group (LAG)]. Results Clinical and echocardiographic response rates of HAG and LAG after CRT were similar in the 3rd and 6th month. In both groups, increase in LVEF and decrease in LV ESV in the 3rd and 6th month were statistically significant compared to those before CRT, and NYHA class and end-diastolic volume (EDV) was significantly reduced in the 6th month compared to those before CRT. However, NHYA class and EDV continued to reduce significantly in HAG from the 3rd to the 6th month (P<0.05), while the decrease in LAG was not significant (P>0.05). The rate of mitral regurgitation (MR) was reduced significantly in HAG in the 6th month compared to that before CRT, while the decrease in LAG was not significant (P<0.05; P>0.05 respectively). Conclusions CRT by high-amplitude LV pacing was more effective according to clinical and echocardiographic evaluations. It should be considered as an alternative in non-responsive patients. PMID:24255779

  4. Higher sympathetic nerve activity during ventricular (VVI) than during dual-chamber (DDD) pacing

    NASA Technical Reports Server (NTRS)

    Taylor, J. A.; Morillo, C. A.; Eckberg, D. L.; Ellenbogen, K. A.

    1996-01-01

    OBJECTIVES: We determined the short-term effects of single-chamber ventricular pacing and dual-chamber atrioventricular (AV) pacing on directly measured sympathetic nerve activity. BACKGROUND: Dual-chamber AV cardiac pacing results in greater cardiac output and lower systemic vascular resistance than does single-chamber ventricular pacing. However, it is unclear whether these hemodynamic advantages result in less sympathetic nervous system outflow. METHODS: In 13 patients with a dual-chamber pacemaker, we recorded the electrocardiogram, noninvasive arterial pressure (Finapres), respiration and muscle sympathetic nerve activity (microneurography) during 3 min of underlying basal heart rate and 3 min of ventricular and AV pacing at rates of 60 and 100 beats/min. RESULTS: Arterial pressure was lowest and muscle sympathetic nerve activity was highest at the underlying basal heart rate. Arterial pressure increased with cardiac pacing and was greater with AV than with ventricular pacing (change in mean blood pressure +/- SE: 10 +/- 3 vs. 2 +/- 2 mm Hg at 60 beats/min; 21 +/- 5 vs. 14 +/- 2 mm Hg at 100 beats/min; p < 0.05). Sympathetic nerve activity decreased with cardiac pacing and the decline was greater with AV than with ventricular pacing (60 beats/min -40 +/- 11% vs. -17 +/- 7%; 100 beats/min -60 +/- 9% vs. -48 +/- 10%; p < 0.05). Although most patients showed a strong inverse relation between arterial pressure and muscle sympathetic nerve activity, three patients with severe left ventricular dysfunction (ejection fraction < or = 30%) showed no relation between arterial pressure and sympathetic activity. CONCLUSIONS: Short-term AV pacing results in lower sympathetic nerve activity and higher arterial pressure than does ventricular pacing, indicating that cardiac pacing mode may influence sympathetic outflow simply through arterial baroreflex mechanisms. We speculate that the greater incidence of adverse outcomes in patients treated with single-chamber ventricular rather than dual-chamber pacing may be due in part to increased sympathetic nervous outflow.

  5. Geometry-Independent Inclusion of Basal Myocardium Yields Improved Cardiac Magnetic Resonance Agreement with Echocardiography and Necropsy Quantified Left Ventricular Mass

    PubMed Central

    SIMPRINI, Lauren A.; GOYAL, Parag; CODELLA, Noel; FIENO, David S.; AFROZ, Anika; MULLALLY, Jamie; COOPER, Mitchell; WANG, Yi; FINN, John Paul; DEVEREUX, Richard B.; WEINSAFT, Jonathan W.

    2014-01-01

    Objectives LV mass (LVM) is widely used to guide clinical decision-making. Cardiac magnetic resonance (CMR) quantifies LVM by planimetry of contiguous short axis images, an approach dependent on reader-selection of images to be contoured. Established methods have applied different binary cutoffs using circumferential extent of LV myocardium to define the basal LV, omitting images containing lesser fractions of LV myocardium. This study tested impact of basal slice variability on LVM quantification. Methods CMR was performed in patients and laboratory animals. LVM was quantified with full inclusion of LV myocardium, and by established methods that use different cutoffs to define the LV basal-most slice: (1) 50% circumferential myocardium at end-diastole alone (ED50), (2) 50% circumferential myocardium throughout both end-diastole and end-systole (EDS50). Results 150 patients and 10 lab animals were studied. Among patients, fully inclusive LVM (172.6±42.3gm) was higher vs. ED50(167.2±41.8gm) and EDS50(150.6±41.1gm; both p<0.001). Methodological differences yielded discrepancies regarding proportion of patients meeting established criteria for LV hypertrophy and chamber dilation (p<0.05). Fully inclusive LVM yielded smaller differences with echocardiography (?=11.0±28.8gm) than did ED50 (?=16.4±29.1gm) and EDS50 (?=33.2±28.7gm, both p<0.001). Among lab animals, ex-vivo LV weight (69.8±13.2gm) was similar to LVM calculated using fully inclusive (70.1±13.5gm, p=0.67) and ED50 (69.4±13.9gm, p=0.70) methods, whereas EDS50 differed significantly (67.9±14.9gm, p=0.04). Conclusions Established CMR methods that discordantly define the basal-most LV produce significant differences in calculated LVM. Fully inclusive quantification, rather than binary cutoffs that omit basal LV myocardium, yields smallest CMR discrepancy with echocardiography-measured LVM and non-significant differences with necropsy-measured LV weight. PMID:24107735

  6. Flow chamber

    DOEpatents

    Morozov, Victor (Manassas, VA)

    2011-01-18

    A flow chamber having a vacuum chamber and a specimen chamber. The specimen chamber may have an opening through which a fluid may be introduced and an opening through which the fluid may exit. The vacuum chamber may have an opening through which contents of the vacuum chamber may be evacuated. A portion of the flow chamber may be flexible, and a vacuum may be used to hold the components of the flow chamber together.

  7. Asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract

    Microsoft Academic Search

    Juan Valiente Mustelier; Julio Oscar Cabrera Rego; Eddy W. Olivares Aquiles; Luis Roberto Llerena

    2010-01-01

    Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunted into a\\u000a cardiac chamber, great vessel or other structure, bypassing the myocardial capillary network (Jung et al. in Cardiovasc Ultrasound\\u000a 5:10, 2007). We present a young adult patient with an asymptomatic fistula from a giant aneurysmatic left anterior descending\\u000a artery to the right ventricular

  8. Effects of occlusion of the left anterior descending coronary artery during angioplasty on right-sided cardiac pressures and electrocardiographic changes.

    PubMed

    Charlap, S; Schulhoff, N; Mylavarapu, S; Greengart, A; Gelbfish, J; Budzilowicz, L; Hollander, G; Lichstein, E; Shani, J

    1989-09-15

    Controversy persists regarding the presence and extent of right ventricular involvement with acute anterior injury. Also unclear are the incidence and significance of ST elevations in the right-sided leads in acute left anterior descending artery occlusion. Baseline and coronary occlusion hemodynamics and 15-lead electrocardiograms (addition of RV3 through RV5) were recorded in 42 patients during 32 left anterior descending and 13 right coronary artery angioplasties. The right coronary and left anterior descending artery angioplasties had similar baseline right and left ventricular hemodynamics, as well as identical right atrial to pulmonary wedge pressure ratios (0.51 right coronary vs 0.51 left anterior descending). Whereas the right coronary and left anterior descending occlusions produced similar elevations in right ventricular filling pressures, the left anterior descending occlusions produced greater elevations in left ventricular filling pressures. The right atrial to pulmonary wedge ratio increased with right coronary occlusions, but was unchanged with left anterior descending occlusions (0.79 right vs 0.46 left, p less than or equal to 0.0001). Presence of right-lead ST elevations in 10 left anterior descending occlusions did not con-note increased right ventricular filling pressures, but did suggest increased left ventricular ischemia and dysfunction. In conclusion, right ventricular dysfunction, as manifested by increased filling pressures, is seen with both right coronary and left anterior descending occlusions. Although it is the predominant abnormality in right coronary occlusions, in left anterior descending occlusions it is proportional to left ventricular dysfunction. ST elevations in a right lead with left anterior descending occlusions do not constitute a marker for increased right ventricular dysfunction. PMID:2528901

  9. Six-Year Experience Routinely Utilizing Moderate Deep Inspiration Breath-hold (mDIBH) for the Reduction of Cardiac Dose in Left-Sided Breast Irradiation for Patients with Early Stage or Locally Advanced Breast Cancer

    PubMed Central

    Swanson, T.; Grills, I.; Ye, H.; Entwistle, A.; Teahan, M.; Letts, N.; Yan, D.; Duquette, J.; Vicini, F.

    2012-01-01

    Purpose/Objectives Moderate Deep Inspiration Breath-hold (mDIBH), utilizing an Active breathing Control (ABC) device has been used in our clinic since 2002 to reduce cardiac dose for patients receiving left-sided breast irradiation. We report our routine use of the mDIBH technique in clinically localized breast cancer, treated to the intact breast, reconstructed breast, or chest wall. Materials/Methods Ninety-nine patients with left sided breast cancer were evaluated for ABC treatment, of which, 87 patients were treated with mDIBH. Plans for both the free-breathing (FB) and mDIBH CT scans were evaluated. Dose volume histograms (DVHs) were analyzed for the heart and ipsilateral lung, comparing results for mDIBH vs FB plans. Results Eighty-seven patients are included for analysis. Of those, 66% received adjuvant chemotherapy with cardiotoxic agents. The mean dose to the whole breast was 47.6 Gy. There was a statistically significant decrease in all DVH parameters evaluated, favoring the delivery of mDIBH over FB plans. mDIBH plans significantly reduced cardiac mean dose (4.23 Gy vs. 2.54 Gy; p<0.001), a relative reduction of 40%. As well, there were significant reductions in all other heart parameters evaluated (i.e volume of heart treated, V30, V25, V20, V15, V10, and V5). mDIBH also significantly reduced lung dose, including a reduction of the left lung mean dose (9.08 Gy vs. 7.86 Gy; p<0.001), a relative reduction of 13%, as well as significant reduction of all lung DVH parameters evaluated. Conclusions To date, this series represents the largest experience utilizing mDIBH to reduce cardiac irradiation during left-sided breast cancer treatment. Statistically significant reductions in all heart and lung DVH parameters were achieved with mDIBH over FB plans. mDIBH, for the treatment of left sided breast cancer, is a proven technique for reducing cardiac dose that may lead to reduced cardiotoxicity and can be routinely integrated into the clinic. PMID:22270108

  10. Determinants of discrepancies in detection and comparison of the prognostic significance of left ventricular hypertrophy by electrocardiogram and cardiac magnetic resonance imaging.

    PubMed

    Bacharova, Ljuba; Chen, Haiying; Estes, E Harvey; Mateasik, Anton; Bluemke, David A; Lima, Joao A C; Burke, Gregory L; Soliman, Elsayed Z

    2015-02-15

    Despite the low sensitivity of the electrocardiogram (ECG) in detecting left ventricular hypertrophy (LVH), ECG-LVH is known to be a strong predictor of cardiovascular risk. Understanding reasons for the discrepancies in detection of LVH by ECG versus imaging could help improve the diagnostic ability of ECG. We examined factors associated with false-positive and false-negative ECG-LVH, using cardiac magnetic resonance imaging (MRI) as the gold standard. We also compared the prognostic significance of ECG-LVH and MRI-LVH as predictors of cardiovascular events. This analysis included 4,748 participants (mean age 61.9 years, 53.5% females, 61.7% nonwhites). Logistic regression with stepwise selection was used to identify factors associated with false-positive (n = 208) and false-negative (n = 387), compared with true-positive (n = 208) and true-negative (n = 4,041) ECG-LVH, respectively. A false-negative ECG-LVH status was associated with increased odds of Hispanic race/ethnicity, current smoking, hypertension, increased systolic blood pressure, prolongation of QRS duration, and higher body mass index and with lower odds of increased ejection fraction (model-generalized R(2) = 0.20). A false-positive ECG-LVH status was associated with lower odds of black race, Hispanic race/ethnicity, minor ST-T abnormalities, increased systolic blood pressure, and presence of any major electrocardiographic abnormalities (model-generalized R(2) = 0.29). Both ECG-LVH and MRI-LVH were associated with an increased risk of cardiovascular disease events (hazard ratio 1.51, 95% confidence interval 1.03 to 2.20 and hazard ratio 1.81, 95% confidence interval 1.33 to 2.46, respectively). In conclusion, discrepancy in LVH detection by ECG and MRI can be relatively improved by considering certain participant characteristics. Discrepancy in diagnostic performance, yet agreement on predictive ability, suggests that LVH by ECG and LVH by imaging are likely to be two distinct but somehow related phenotypes. PMID:25542394

  11. Vector Selection of a Quadripolar Left Ventricular Pacing Lead Affects Acute Hemodynamic Response to Cardiac Resynchronization Therapy: A Randomized Cross-Over Trial

    PubMed Central

    Asbach, Stefan; Hartmann, Maximilian; Wengenmayer, Tobias; Graf, Erika; Bode, Christoph; Biermann, Juergen

    2013-01-01

    Background A suboptimal left ventricular (LV) pacing site may account for non-responsiveness of patients to cardiac resynchronization therapy (CRT). The vector selection of a novel quadripolar LV pacing lead, which was mainly developed to overcome technical issues with stimulation thresholds and phrenic nerve capture, may affect hemodynamic response, and was therefore assessed in this study. (German Clinical Trials Register DRKS00000573). Methods and Results Hemodynamic effects of a total of 145 LVPCs (9.1 per patient) of CRT devices with a quadripolar LV lead (Quartet™, St. Jude Medical) were assessed in 16/20 consecutive patients by invasive measurement of LV+dP/dtmax at an invasively optimized AV-interval in random order. Optimal (worst) LVPCs per patient were identified as those with maximal (minimal) %change in LV+dP/dtmax (%?LV+dP/dtmax) as compared to a preceding baseline. LV+dP/dtmax significantly increased in all 145 LVPCs (p<0.0001 compared to baseline) with significant intraindividual differences between LVPCs (p<0.0001). Overall, CRT acutely augmented %?LV+dP/dtmax by 31.3% (95% CI 24%–39%) in the optimal, by 21.3% (95% CI: 15%–27%) in the worst and by 28.2% (95% CI: 21%–36%) in a default distal LVPC. This resulted in an absolute additional acute increase in %?LV+dP/dtmax of 10.0% (95% CI: 7%–13%) of the optimal when compared to the worst (p<0.0001), and of 3.1% (95% CI: 1%–5%) of the optimal when compared to the default distal LVPC (p<0.001). Optimal LVPCs were not programmable with a standard bipolar lead in 44% (7/16) of patients. Conclusion The pacing configuration of a quadripolar LV lead determinates acute hemodynamic response. Pacing in the individually optimized configuration gives rise to an additional absolute 10% increase in %?LV+dP/dtmax when comparing optimal and worst vectors. PMID:23826245

  12. Characterization of Respiratory and Cardiac Motion from Electro-Anatomical Mapping Data for Improved Fusion of MRI to Left Ventricular Electrograms

    PubMed Central

    Roujol, Sébastien; Anter, Elad; Josephson, Mark E.; Nezafat, Reza

    2013-01-01

    Accurate fusion of late gadolinium enhancement magnetic resonance imaging (MRI) and electro-anatomical voltage mapping (EAM) is required to evaluate the potential of MRI to identify the substrate of ventricular tachycardia. However, both datasets are not acquired at the same cardiac phase and EAM data is corrupted with respiratory motion limiting the accuracy of current rigid fusion techniques. Knowledge of cardiac and respiratory motion during EAM is thus required to enhance the fusion process. In this study, we propose a novel approach to characterize both cardiac and respiratory motion from EAM data using the temporal evolution of the 3D catheter location recorded from clinical EAM systems. Cardiac and respiratory motion components are extracted from the recorded catheter location using multi-band filters. Filters are calibrated for each EAM point using estimates of heart rate and respiratory rate. The method was first evaluated in numerical simulations using 3D models of cardiac and respiratory motions of the heart generated from real time MRI data acquired in 5 healthy subjects. An accuracy of 0.6–0.7 mm was found for both cardiac and respiratory motion estimates in numerical simulations. Cardiac and respiratory motions were then characterized in 27 patients who underwent LV mapping for treatment of ventricular tachycardia. Mean maximum amplitude of cardiac and respiratory motion was 10.2±2.7 mm (min?=?5.5, max?=?16.9) and 8.8±2.3 mm (min?=?4.3, max?=?14.8), respectively. 3D Cardiac and respiratory motions could be estimated from the recorded catheter location and the method does not rely on additional imaging modality such as X-ray fluoroscopy and can be used in conventional electrophysiology laboratory setting. PMID:24250815

  13. Registration-based segmentation of murine 4D cardiac micro-CT data using symmetric normalization

    NASA Astrophysics Data System (ADS)

    Clark, Darin; Badea, Alexandra; Liu, Yilin; Johnson, G. Allan; Badea, Cristian T.

    2012-10-01

    Micro-CT can play an important role in preclinical studies of cardiovascular disease because of its high spatial and temporal resolution. Quantitative analysis of 4D cardiac images requires segmentation of the cardiac chambers at each time point, an extremely time consuming process if done manually. To improve throughput this study proposes a pipeline for registration-based segmentation and functional analysis of 4D cardiac micro-CT data in the mouse. Following optimization and validation using simulations, the pipeline was applied to in vivo cardiac micro-CT data corresponding to ten cardiac phases acquired in C57BL/6 mice (n = 5). After edge-preserving smoothing with a novel adaptation of 4D bilateral filtration, one phase within each cardiac sequence was manually segmented. Deformable registration was used to propagate these labels to all other cardiac phases for segmentation. The volumes of each cardiac chamber were calculated and used to derive stroke volume, ejection fraction, cardiac output, and cardiac index. Dice coefficients and volume accuracies were used to compare manual segmentations of two additional phases with their corresponding propagated labels. Both measures were, on average, >0.90 for the left ventricle and >0.80 for the myocardium, the right ventricle, and the right atrium, consistent with trends in inter- and intra-segmenter variability. Segmentation of the left atrium was less reliable. On average, the functional metrics of interest were underestimated by 6.76% or more due to systematic label propagation errors around atrioventricular valves; however, execution of the pipeline was 80% faster than performing analogous manual segmentation of each phase.

  14. Right coronary artery fistula to left ventricle treated by transcatheter coil embolization: a case report and literature review.

    PubMed

    Jiang, Zhenni; Chen, Han; Wang, Jian'an

    2012-01-01

    A coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition. We reported a case of right coronary artery fistula to the left ventricle in a 57-year-old man who had 2-year history of chest pain and exercise dyspnea without significant coronary atherosclerosis with abnormal left ventricular size and function. It was important to recognize this anomaly and our experience showed that transcatheter occlusion of coronary artery fistula was a safe and effective procedure in the presence of symptoms of congestive heart failure, significant left-to-right shunt or refractory to medical treatment. PMID:22687840

  15. Design and Rationale of the PRAGUE-12 Trial: A Large, Prospective, Randomized, Multicenter Trial That Compares Cardiac Surgery With Left Atrial Surgical Ablation With Cardiac Surgery Without Ablation in Patients With Coronary and/or Valvular Heart Disease Plus Atrial Fibrillation

    PubMed Central

    Straka, Zbyn?k; Budera, Petr; Osman?ík, Pavel; Van?k, Tomáš; Hulman, Michal; Šmíd, Michal; Malý, Marek; Widimský, Petr

    2013-01-01

    Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac surgery alone). The primary efficacy outcome is the SR presence (without any AF episode) during a 24-hour electrocardiogram after 1 year. The primary safety outcome is the combined end point of death, myocardial infarction, stroke, and renal failure at 30 days. Long-term outcomes are a composite of total mortality, stroke, bleeding, and heart failure at 1 and 5 years. We finished the enrollment with a total of 224 patients from 3 centers in 2 countries in December 2011. Currently, the incomplete 1-year data are available, and the patients who enrolled first will have their 5-year visits shortly. PRAGUE-12 is the largest study to be conducted so far comparing cardiac surgery with surgical ablation of AF to cardiac surgery without ablation in an unselected population of patients who are operated on for coronary and/or valve disease. Its long-term results will lead to a better recognition of ablation's potential clinical benefits. PMID:23280480

  16. Blunt traumatic cardiac rupture. A 5-year experience.

    PubMed Central

    Brathwaite, C E; Rodriguez, A; Turney, S Z; Dunham, C M; Cowley, R

    1990-01-01

    Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients. PMID:2256761

  17. Cardiac-Specific Inhibition of Kinase Activity in Calcium/Calmodulin-Dependent Protein Kinase Kinase-? Leads to Accelerated Left Ventricular Remodeling and Heart Failure after Transverse Aortic Constriction in Mice

    PubMed Central

    Watanabe, Shin; Horie, Takahiro; Nagao, Kazuya; Kuwabara, Yasuhide; Baba, Osamu; Nishi, Hitoo; Sowa, Naoya; Narazaki, Michiko; Matsuda, Tetsuya; Takemura, Genzou; Wada, Hiromichi; Hasegawa, Koji; Kimura, Takeshi; Ono, Koh

    2014-01-01

    Background The mechanism of cardiac energy production against sustained pressure overload remains to be elucidated. Methods and Results We generated cardiac-specific kinase-dead (kd) calcium/calmodulin-dependent protein kinase kinase-? (CaMKK?) transgenic (?-MHC CaMKK?kd TG) mice using ?-myosin heavy chain (?-MHC) promoter. Although CaMKK? activity was significantly reduced, these mice had normal cardiac function and morphology at baseline. Here, we show that transverse aortic binding (TAC) in ?-MHC CaMKK?kd TG mice led to accelerated death and left ventricular (LV) dilatation and dysfunction, which was accompanied by significant clinical signs of heart failure. CaMKK? downstream signaling molecules, including adenosine monophosphate-activated protein kinase (AMPK), were also suppressed in ?-MHC CaMKK?kd TG mice compared with wild-type (WT) mice. The expression levels of peroxisome proliferator-activated receptor-? coactivator (PGC)-1?, which is a downstream target of both of CaMKK? and calcium/calmodulin kinases, were also significantly reduced in ?-MHC CaMKK?kd TG mice compared with WT mice after TAC. In accordance with these findings, mitochondrial morphogenesis was damaged and creatine phosphate/?-ATP ratios assessed by magnetic resonance spectroscopy were suppressed in ?-MHC CaMKK?kd TG mice compared with WT mice after TAC. Conclusions These data indicate that CaMKK? exerts protective effects on cardiac adaptive energy pooling against pressure-overload possibly through phosphorylation of AMPK and by upregulation of PGC-1?. Thus, CaMKK? may be a therapeutic target for the treatment of heart failure. PMID:25255457

  18. A Rare Case of Left Ventricular Intramural Hemangioma Diagnosed Using 1.5-T Cardiac MRI with Histopathological Correlation and Successfully Treated by Surgery

    SciTech Connect

    Marrone, Gianluca, E-mail: gmarrone@ismett.ed [Mediterranean Institute of Transplantation and High Specialization Therapy (ISMETT), Diagnostic and Interventional Radiology (Italy); Sciacca, Sergio, E-mail: ssciacca@ismett.edu; D'Ancona, Giuseppe, E-mail: gdancona@ismett.edu; Pilato, Michele, E-mail: mpilato@ismett.ed [Mediterranean Institute of Transplantation and High Specialization Therapy (ISMETT), Division of Cardiac Surgery (Italy); Luca, Angelo, E-mail: aluca@ismett.ed [Mediterranean Institute of Transplantation and High Specialization Therapy (ISMETT), Diagnostic and Interventional Radiology (Italy); Gridelli, Bruno, E-mail: bgridelli@ismett.ed [Mediterranean Institute of Transplantation and High Specialization Therapy (ISMETT), Division of Surgery (Italy)

    2010-02-15

    Hemangiomas are vascular tumors composed of blood vessels, frequently localized in the skin and subcutaneous muscles; their localization in the heart is exceptional. The most common localizations are the lateral walls of the left ventricle, the anterior wall, and the septum. Mostly, these tumors grow intracavitarily, rarely intramurally. We describe a singular case of left ventricular intramural hemangioma, detected and diagnosed using newer magnetic resonance imaging (MRI) modalities, confirmed by histopathological results, and treated successfully by surgery.

  19. Time Components of the Left Ventricle.

    ERIC Educational Resources Information Center

    Franks, B. Don

    The purpose of this study was to examine the relationship of the time components of the left ventricle. Since one of the ways to investigate cardiac function is to analyze the time intervals between particular events of the cardiac cycle, various time intervals of systole and diastole of the left ventricle were measured from simultaneous…

  20. Biomechanics of Early Cardiac Development

    PubMed Central

    Goenezen, Sevan; Rennie, Monique Y.

    2012-01-01

    Biomechanics affect early cardiac development, from looping to the development of chambers and valves. Hemodynamic forces are essential for proper cardiac development, and their disruption leads to congenital heart defects. A wealth of information already exists on early cardiac adaptations to hemodynamic loading, and new technologies, including high resolution imaging modalities and computational modeling, are enabling a more thorough understanding of relationships between hemodynamics and cardiac development. Imaging and modeling approaches, used in combination with biological data on cell behavior and adaptation, are paving the road for new discoveries on links between biomechanics and biology and their effect on cardiac development and fetal programming. PMID:22760547

  1. Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions

    PubMed Central

    2012-01-01

    Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a “four-chamber” and “LVOT view” was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases. PMID:22862855

  2. Electrostatic Levitator Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical ports ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (beam passes through the window at left), positioning lasers (one port is at center), and lamps to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  3. Platelet Endothelial Cell Adhesion Molecule?1 Mediates Endothelial?Cardiomyocyte Communication and Regulates Cardiac Function

    PubMed Central

    McCormick, Margaret E.; Collins, Caitlin; Makarewich, Catherine A.; Chen, Zhongming; Rojas, Mauricio; Willis, Monte S.; Houser, Steven R.; Tzima, Ellie

    2015-01-01

    Background Dilated cardiomyopathy is characterized by impaired contractility of cardiomyocytes, ventricular chamber dilatation, and systolic dysfunction. Although mutations in genes expressed in the cardiomyocyte are the best described causes of reduced contractility, the importance of endothelial?cardiomyocyte communication for proper cardiac function is increasingly appreciated. In the present study, we investigate the role of the endothelial adhesion molecule platelet endothelial cell adhesion molecule (PECAM?1) in the regulation of cardiac function. Methods and Results Using cell culture and animal models, we show that PECAM?1 expressed in endothelial cells (ECs) regulates cardiomyocyte contractility and cardiac function via the neuregulin?ErbB signaling pathway. Conscious echocardiography revealed left ventricular (LV) chamber dilation and systolic dysfunction in PECAM?1?/? mice in the absence of histological abnormalities or defects in cardiac capillary density. Despite deficits in global cardiac function, cardiomyocytes isolated from PECAM?1?/? hearts displayed normal baseline and isoproterenol?stimulated contractility. Mechanistically, absence of PECAM?1 resulted in elevated NO/ROS signaling and NRG?1 release from ECs, which resulted in augmented phosphorylation of its receptor ErbB2. Treatment of cardiomyocytes with conditioned media from PECAM?1?/? ECs resulted in enhanced ErbB2 activation, which was normalized by pre?treatment with an NRG?1 blocking antibody. To determine whether normalization of increased NRG?1 levels could correct cardiac function, PECAM?1?/? mice were treated with the NRG?1 blocking antibody. Echocardiography showed that treatment significantly improved cardiac function of PECAM?1?/? mice, as revealed by increased ejection fraction and fractional shortening. Conclusions We identify a novel role for PECAM?1 in regulating cardiac function via a paracrine NRG1?ErbB pathway. These data highlight the importance of tightly regulated cellular communication for proper cardiac function. PMID:25600142

  4. Cardiac Rehabilitation

    MedlinePLUS

    ... from the NHLBI on Twitter. What Is Cardiac Rehabilitation? Cardiac rehabilitation (rehab) is a medically supervised program ... be designed to meet your needs. The Cardiac Rehabilitation Team Cardiac rehab involves a long-term commitment ...

  5. A biplane roentgen videometry system for dynamic /60 per second/ studies of the shape and size of circulatory structures, particularly the left ventricle.

    NASA Technical Reports Server (NTRS)

    Ritman, E. L.; Sturm, E.; Wood, E. H.; Heintzen, P. H.

    1971-01-01

    A roentgen-television digital-computer technique and a display system developed for dynamic circulatory structure studies are described. Details are given for a videoroentgenographic setup which is used for obtaining biplane roentgen silhouettes of a left ventricle. A 60 per sec measurement of the shape and volume of angiographically outlined cardiac chambers can be made by this technique along with simultaneous ECG, pressure, and flow measurements accessible for real-time digital computer processing and analysis.

  6. Long QT syndrome due to a novel mutation in SCN5A: treatment with ICD placement at 1 month and left cardiac sympathetic denervation at 3 month of age

    PubMed Central

    Silver, Eric S.; Liberman, Leonardo; Chung, Wendy K.; Spotnitz, Henry M.; Chen, Jonathan M.; Ackerman, Michael J.; Moir, Christopher; Hordof, Allan J.

    2012-01-01

    We describe the case of a newborn with congenital long QT syndrome, with 2:1 AV block and frequent episodes of Torsades de Pointes (TdP) requiring placement of a dual chamber ICD at 33 days and 3.63 kg, the youngest and smallest patient, thus far reported. Long QT syndrome was diagnosed due to bradycardia in the newborn nursery, with frequent episodes of TdP. The patient was initially treated with magnesium and esmolol then given lidocaine which resulted in dramatic transient normalization of the QTc with 1:1 AV nodal conduction. An attempt to transition to oral sodium channel and beta blockade was unsuccessful. An ICD was placed and dual chamber pacing was initiated which facilitated the transition to an oral medical regimen and ultimate discharge from the hospital. Soon after placement of the ICD, genetic testing revealed a novel F1473C mutation in the SCN5A gene. Episodes of TdP continued and left stellate gangliectomy was performed at 3 months of age. At 30 months follow-up, the patient has occasional, self-limited episodes of TdP and has received rare, successful, and appropriate ICD shocks. PMID:19669871

  7. L-Arginine ameliorates cardiac left ventricular oxidative stress by upregulating eNOS and Nrf2 target genes in alloxan-induced hyperglycemic rats

    SciTech Connect

    Ramprasath, Tharmarajan; Hamenth Kumar, Palani; Syed Mohamed Puhari, Shanavas; Senthil Murugan, Ponniah; Vasudevan, Varadaraj [Molecular Cardiology Unit, Department of Biochemistry, Center for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamilnadu (India)] [Molecular Cardiology Unit, Department of Biochemistry, Center for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamilnadu (India); Selvam, Govindan Sadasivam, E-mail: drselvamgsbiochem@rediffmail.com [Molecular Cardiology Unit, Department of Biochemistry, Center for Excellence in Genomic Sciences, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamilnadu (India)

    2012-11-23

    Highlights: Black-Right-Pointing-Pointer L-Arginine treatment reduced the metabolic disturbances in diabetic animals. Black-Right-Pointing-Pointer Antioxidant marker proteins were found high in myocardium by L-arginine treatment. Black-Right-Pointing-Pointer Elevated antioxidant status, mediates the reduced TBA-reactivity in left ventricle. Black-Right-Pointing-Pointer L-Arginine treatment enhanced the Nrf2 and eNOS signaling in left ventricle. Black-Right-Pointing-Pointer Improved cell survival signaling by arginine, offers a novel tactic for targeting. -- Abstract: Hyperglycemia is independently related with excessive morbidity and mortality in cardiovascular disorders. L-Arginine-nitric oxide (NO) pathway and the involvement of NO in modulating nuclear factor-E2-related factor-2 (Nrf2) signaling were well established. In the present study we investigated, whether L-arginine supplementation would improve the myocardial antioxidant defense under hyperglycemia through activation of Nrf2 signaling. Diabetes was induced by alloxan monohydrate (90 mg kg{sup -1} body weight) in rats. Both non-diabetic and diabetic group of rats were divided into three subgroups and they were administered either with L-arginine (2.25%) or L-NAME (0.01%) in drinking water for 12 days. Results showed that L-arginine treatment reduced the metabolic disturbances in diabetic rats. Antioxidant enzymes and glutathione levels were found to be increased in heart left ventricles, thereby reduction of lipid peroxidation by L-arginine treatment. Heart histopathological analysis further validates the reversal of typical diabetic characteristics consisting of alterations in myofibers and myofibrillary degeneration. qRT-PCR studies revealed that L-arginine treatment upregulated the transcription of Akt and downregulated NF-{kappa}B. Notably, transcription of eNOS and Nrf2 target genes was also upregulated, which were accompanied by enhanced expression of Nrf2 in left ventricular tissue from diabetic and control rats. Under these findings, we suggest that targeting of eNOS and Nrf2 signaling by L-arginine supplementation could be used as a potential treatment method to alleviate the late diabetic complications.

  8. [Validity of electrocardiographic indices of left ventricular hypertrophy in athletes].

    PubMed

    Cottini, E; Lisi, M; Maria, N; Martelli, V; Corsini, M; Raspagliesi, M; Tamburino, C

    1989-09-01

    The Authors have evaluated the reliability of the most important electrocardiographic criteria for left ventricular hypertrophy in a group of 95 athletes. An ECG and a M- and B-mode echocardiogram have been performed in each subject; the criteria by Sokolow and Lyon, by Cornell, by Gubner, by Romhilt and Estes and by Casale have been employed to evaluate left ventricular hypertrophy. Left ventricular mass has been evaluated by the echocardiogram according to Devereux and coll. The electrocardiographic method by Casale and coll., proposed only for a few years, is based on the valuation of R wave and on the study of ventricular repolarization depending on sex and age. By this method, still now not much used in the study of athletes, a good correlation with the echocardiographic data was expected, in relation to the young age of the population. The athletes have been divided into three groups, practising aerobic sports, aerobic-anaerobic sports and power sports, according to the physiologic classification of the sports activities of Dal Monte. Using the chi-squared test, for the whole population and separately for the three groups, no significant statistical correlation has been observed. In conclusion, the results demonstrate that not only the "classic" criteria, but also the most recent ECG criteria of left ventricular hypertrophy are not reliable in evaluating left ventricular hypertrophy in trained athletes, leaving the final assessment of the real state of the cardiac chambers to echocardiography. PMID:2532715

  9. Repair of isolated double-chambered right ventricle.

    PubMed

    El Kouache, M; Babakhoya, A; Labib, S; El Madi, A; Atmani, S; Harandou, M; Abouabdilah, Y; Hida, M

    2013-01-01

    The finding of a double-chambered right ventricle (DCRV) is exceptionally rare as an isolated anomaly. It is a congenital cardiac anomaly in which the right ventricle is separated into two chambers, a proximal high-pressure chamber and a distal low-pressure chamber, by anomalous muscles or fibrous tissues in the right ventricular cavity. We report the case of a 6-year-old infant who was admitted for growth retardation. The patient was diagnosed with an isolated DCRV without any other associated congenital anomalies. The patient underwent a successful cardiac surgical procedure of enlargement repair; he was discharged in good clinical condition with a normal cardiac function. PMID:23860078

  10. Exposure chamber

    DOEpatents

    Moss, Owen R. (Kennewick, WA)

    1980-01-01

    A chamber for exposing animals, plants, or materials to air containing gases or aerosols is so constructed that catch pans for animal excrement, for example, serve to aid the uniform distribution of air throughout the chamber instead of constituting obstacles as has been the case in prior animal exposure chambers. The chamber comprises the usual imperforate top, bottom and side walls. Within the chamber, cages and their associated pans are arranged in two columns. The pans are spaced horizontally from the walls of the chamber in all directions. Corresponding pans of the two columns are also spaced horizontally from each other. Preferably the pans of one column are also spaced vertically from corresponding pans of the other column. Air is introduced into the top of the chamber and withdrawn from the bottom. The general flow of air is therefore vertical. The effect of the horizontal pans is based on the fact that a gas flowing past the edge of a flat plate that is perpendicular to the flow forms a wave on the upstream side of the plate. Air flows downwardly between the chamber walls and the outer edges of the pan. It also flows downwardly between the inner edges of the pans of the two columns. It has been found that when the air carries aerosol particles, these particles are substantially uniformly distributed throughout the chamber.

  11. Wire chamber

    DOEpatents

    Atac, Muzaffer (Wheaton, IL)

    1989-01-01

    A wire chamber or proportional counter device, such as Geiger-Mueller tube or drift chamber, improved with a gas mixture providing a stable drift velocity while eliminating wire aging caused by prior art gas mixtures. The new gas mixture is comprised of equal parts argon and ethane gas and having approximately 0.25% isopropyl alcohol vapor.

  12. CT Imaging: Cardiac Electrophysiology Applications

    Microsoft Academic Search

    Jerold S. Shinbane; Marc J. Girsky; Leslie A. Saxon; Michael K. Cao; David A. Cesario; Matthew J. Budoff

    \\u000a An understanding of detailed 3-D cardiac anatomy is important to the field of cardiac electrophysiology. Cardiovascular computed\\u000a tomographic angiography (CCTA) can comprehensively assess cardiovascular structure and function relevant to the assessment,\\u000a treatment, and follow-up of patients with electrophysiologically-related disease processes. CCTA provides 3-D visualization\\u000a of cardiac chambers, coronary vessels, and thoracic vasculature including structures particularly important to cardiac electrophysiology,\\u000a such

  13. Heart rate reduction for 36 months with ivabradine reduces left ventricular mass in cardiac allograft recipients: a long-term follow-up study

    PubMed Central

    Doesch, Andreas O; Mueller, Susanne; Erbel, Christian; Gleissner, Christian A; Frankenstein, Lutz; Hardt, Stefan; Ruhparwar, Arjang; Ehlermann, Philipp; Dengler, Thomas; Katus, Hugo A

    2013-01-01

    Background Due to graft denervation, sinus tachycardia is a common problem after heart transplantation, underlining the importance of heart rate control without peripheral effects. However, long-term data regarding the effects of ivabradine, a novel If channel antagonist, are limited in patients after heart transplantation. Methods In this follow-up analysis, the resting heart rate, left ventricular mass indexed to body surface area (LVMI), tolerability, and safety of ivabradine therapy were evaluated at baseline and after 36 months in 30 heart transplant recipients with symptomatic sinus tachycardia versus a matched control group. Results During the study period, ivabradine medication was stopped in three patients (10% of total). Further analysis was based on 27 patients with 36 months of drug intake. The mean patient age was 53.3±11.3 years and mean time after heart transplantation was 5.0±4.8 years. After 36 months, the mean ivabradine dose was 12.0±3.4 mg/day. Resting heart rate was reduced from 91.0±10.7 beats per minute before initiation of ivabradine therapy (ie, baseline) to 81.2±9.8 beats per minute at follow-up (P=0.0006). After 36 months of ivabradine therapy, a statistically significant reduction of LVMI was observed (104.3±22.7 g at baseline versus 93.4±18.4 g at follow-up, P=0.002). Hematologic, renal, and liver function parameters remained stable during ivabradine therapy. Except for a lower mycophenolate mofetil dose at follow-up (P=0.02), no statistically significant changes in immunosuppressive drug dosage or blood levels were detected. No phosphenes were observed during 36 months of ivabradine intake despite active inquiry. Conclusion In line with previously published 12-month data, heart rate reduction with ivabradine remained effective and safe in chronic stable patients after heart transplantation, and also during 36-month long-term follow-up. Further, a significant reduction of LVMI was observed only during ivabradine therapy. Therefore, ivabradine may have a sustained long-term beneficial effect with regard to left ventricular remodeling in heart transplant patients. PMID:24235815

  14. Automatic classification of scar tissue in late gadolinium enhancement cardiac MRI for the assessment of left-atrial wall injury after radiofrequency ablation

    NASA Astrophysics Data System (ADS)

    Perry, Daniel; Morris, Alan; Burgon, Nathan; McGann, Christopher; MacLeod, Robert; Cates, Joshua

    2012-03-01

    Radiofrequency ablation is a promising procedure for treating atrial fibrillation (AF) that relies on accurate lesion delivery in the left atrial (LA) wall for success. Late Gadolinium Enhancement MRI (LGE MRI) at three months post-ablation has proven effective for noninvasive assessment of the location and extent of scar formation, which are important factors for predicting patient outcome and planning of redo ablation procedures. We have developed an algorithm for automatic classification in LGE MRI of scar tissue in the LA wall and have evaluated accuracy and consistency compared to manual scar classifications by expert observers. Our approach clusters voxels based on normalized intensity and was chosen through a systematic comparison of the performance of multivariate clustering on many combinations of image texture. Algorithm performance was determined by overlap with ground truth, using multiple overlap measures, and the accuracy of the estimation of the total amount of scar in the LA. Ground truth was determined using the STAPLE algorithm, which produces a probabilistic estimate of the true scar classification from multiple expert manual segmentations. Evaluation of the ground truth data set was based on both inter- and intra-observer agreement, with variation among expert classifiers indicating the difficulty of scar classification for a given a dataset. Our proposed automatic scar classification algorithm performs well for both scar localization and estimation of scar volume: for ground truth datasets considered easy, variability from the ground truth was low; for those considered difficult, variability from ground truth was on par with the variability across experts.

  15. The LionHeart LVD-2000: a completely implanted left ventricular assist device for chronic circulatory support.

    PubMed

    Mehta, S M; Pae, W E; Rosenberg, G; Snyder, A J; Weiss, W J; Lewis, J P; Frank, D J; Thompson, J J; Pierce, W S

    2001-03-01

    Management of patients with end-stage cardiac disease remains a vexing problem. Limitations in medical management and a fixed supply of donor organs for cardiac transplant have a continued impact on this growing population of patients. Mechanical circulatory support has proved very successful as a means of bridging patients to cardiac transplant when all medical options have been exhausted. The development of a chronic system of circulatory support has been underway at the Pennsylvania State University for nearly 30 years. These efforts have been recently merged with the industrial partnership with Arrow International toward the development of the LionHeart LVD-2000 (Arrow International, Reading, PA) completely implanted left ventricular support system. We present an overview of the system, details of implantation, a review of preclinical studies, and a synopsis of the first European implants. Early results have demonstrated the system to be safe, effective, and reliable. Transcutaneous energy transmission and the compliance chamber have been validated. PMID:11265852

  16. Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation

    NASA Technical Reports Server (NTRS)

    Makikallio, T. H.; Hoiber, S.; Kober, L.; Torp-Pedersen, C.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

    1999-01-01

    A number of new methods have been recently developed to quantify complex heart rate (HR) dynamics based on nonlinear and fractal analysis, but their value in risk stratification has not been evaluated. This study was designed to determine whether selected new dynamic analysis methods of HR variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction <35%) after an AMI. By the end of 4-year follow-up, 72 patients (45%) had died and 87 (55%) were still alive. Short-term scaling exponent alpha (1.07 +/- 0.26 vs 0.90 +/- 0.26, p <0.001) and power-law slope beta (-1.35 +/- 0.23 vs -1.44 +/- 0.25, p <0.05) differed between survivors and those who died, but none of the traditional HR variability measures differed between these groups. Among all analyzed variables, reduced scaling exponent alpha (<0.85) was the best univariable predictor of mortality (relative risk 3.17, 95% confidence interval 1.96 to 5.15, p <0.0001), with positive and negative predictive accuracies of 65% and 86%, respectively. In the multivariable Cox proportional hazards analysis, mortality was independently predicted by the reduced exponent alpha (p <0.001) after adjustment for several clinical variables and LV function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death after AMI.

  17. Therapeutic hypothermia in combination with percutaneous coronary intervention in out-of-hospital cardiac arrest due to left main coronary artery disease.

    PubMed

    Kurisu, Satoshi; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Shimatani, Yuji; Nakama, Yasuharu; Maruhashi, Tatsuya; Kagawa, Eisuke; Dai, Kazuoki; Matsushita, Junichi; Ikenaga, Hiroki

    2009-09-01

    A 59-year-old man had a witnessed collapse while driving a car. Approximately 10 min after the call to emergency services, paramedics arrived and initiated cardiopulmonary resuscitation. The first electrocardiogram (ECG) obtained by paramedics showed pulseless electrical activity. Review of his prehospital records documented that he experienced approximately 13 min of no flow or low flow before return of spontaneous circulation. On admission, he was still comatose with midrange dilated pupils. Electrocardiogram showed sinus rhythm, ST segment elevation in lead aVR, and ST segment depression in leads I, II, and V4-6. Coronary angiography showed 99% narrowing of the left main coronary artery (LMCA), but did not show any disease in the right coronary artery. A bare-metal stent was placed in the LMCA, and postdilated at 20 atmospheres. Immediately after return to the coronary care unit, therapeutic hypothermia was initiated. Hypothermia with a target temperature of 33.0 degrees C was maintained for 30 h. During this period, no significant hemodynamic instability occurred under intra-aortic balloon pumping (IABP) and intravenous catecholamines. Subsequently, he was slowly rewarmed at a rate of 0.3 degrees C/h up to 36.0 degrees C. Next day, the neurological condition improved and IABP was stopped. Creatine kinase increased to 2182 IU/l. Stent thrombosis did not occur despite the ad hoc loading of antiplatelet drugs. Follow-up echocardiography 9 days later showed mild hypokinesia of the anterior wall with an ejection fraction of 77%. He was discharged with no neurologic complications 18 days later. PMID:19784822

  18. Digital cardiac imaging

    SciTech Connect

    Buda, A.J.; Delp, E.J.

    1985-01-01

    This book contains 16 papers. Some of the titles are: The analysis of left ventricular function with digital subtraction angiography; Digital radiographic assessment of coronary flow reserve; Clinical application of cardiac CT; Digital two-dimensional echocardiography; and Magnetic resonance imaging of the heart.

  19. Primary Cardiac Angiofibroma

    PubMed Central

    Kim, Young Ju; Kim, Young Jin; Kim, Se Hoon; Youn, Young-Nam

    2013-01-01

    Cardiac Angiofibroma is an uncommon intracardiac tumor. Thus far, only 4 cases of the rare intracardiac tumor have been reported. The present case-report describes an intracardiac angiofibroma in a 57-year-old healthy female. The patient was incidentally diagnosed with a left ventricle mass during echocardiography. We performed cardiac imaging, surgical excision and histological evaluation of the mass. The angiofibroma demonstrated features different from the relatively common cardiac tumors such as fibroma, myxoma and angiosarcoma. The cardiac MRI showed slightly high signal intensity on both T1 and T2, with the central core of lower signal intensity. The resected tumor was a whitish and rubbery mass. Histologically, the tumor showed the benign vascular proliferations associated with the surrounding collagen deposition. PMID:24174966

  20. Rapidly progressing left atrial hemangiopericytoma.

    PubMed

    Nakamura, Tamami; Ito, Hiroshi; Sakata, Kensuke; Kobayashi, Yurio

    2014-04-15

    Cardiac hemangiopericytoma is a rare soft tissue tumor. We describe a case of hemangiopericytoma in the left atrium, which was diagnosed as myxoma preoperatively. A 70-year-old woman was admitted with heart failure. An echocardiogram showed a large myxoma-like mass in the left atrium, herniating into the left ventricle; therefore, an emergency operation was performed. Histological examination revealed a malignant hemangiopericytoma. The patient's postoperative course was uneventful, but she died due to a local recurrence 4 months after the operation. PMID:24696103

  1. Cardiac Magnetic Resonance Imaging Findings in 20-year Survivors of Mediastinal Radiotherapy for Hodgkin's Disease

    SciTech Connect

    Machann, Wolfram; Beer, Meinrad [Department of Radiology, University of Wuerzburg (Germany); Breunig, Margret; Stoerk, Stefan; Angermann, Christiane [Department of Cardiology, University of Wuerzburg (Germany); Seufert, Ines; Schwab, Franz; Koelbl, Oliver; Flentje, Michael [Department of Radiation Oncology, University of Wuerzburg (Germany); Vordermark, Dirk, E-mail: dirk.vordermark@medizin.uni-halle.d [Department of Radiation Oncology, University of Wuerzburg (Germany); Department of Radiation Oncology, Martin Luther University Halle-Wittenberg (Germany)

    2011-03-15

    Purpose: The recognition of the true prevalence of cardiac toxicity after mediastinal radiotherapy requires very long follow-up and a precise diagnostic procedure. Cardiac magnetic resonance imaging (MRI) permits excellent quantification of cardiac function and identification of localized myocardial defects and has now been applied to a group of 20-year Hodgkin's disease survivors. Methods and materials: Of 143 patients treated with anterior mediastinal radiotherapy (cobalt-60, median prescribed dose 40 Gy) for Hodgkin's disease between 1978 and 1985, all 53 survivors were invited for cardiac MRI. Of those, 36 patients (68%) presented for MRI, and in 31 patients (58%) MRI could be performed 20-28 years (median, 24) after radiotherapy. The following sequences were acquired on a 1.5-T MRI: transversal T1-weighted TSE and T2-weighted half-fourier acquisition single-shot turbo-spin-echo sequences, a steady-state free precession (SSFP) cine sequence in the short heart axis and in the four-chamber view, SSFP perfusion sequences under rest and adenosine stress, and a SSFP inversion recovery sequence for late enhancement. The MRI findings were correlated with previously reconstructed doses to cardiac structures. Results: Clinical characteristics and reconstructed doses were not significantly different between survivors undergoing and not undergoing MRI. Pathologic findings were reduced left ventricular function (ejection fraction <55%) in 7 (23%) patients, hemodynamically relevant valvular dysfunction in 13 (42%), late myocardial enhancement in 9 (29%), and any perfusion deficit in 21 (68%). An association of regional pathologic changes and reconstructed dose to cardiac structures could not be established. Conclusions: In 20-year survivors of Hodgkin's disease, cardiac MRI detects pathologic findings in approximately 70% of patients. Cardiac MRI has a potential role in cardiac imaging of Hodgkin's disease patients after mediastinal radiotherapy.

  2. Electrostatic Levitator Vaccum Chamber

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical ports ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (the beam passes through the window at left), positioning lasers (one port is at center), and lamps (such as the deuterium arc lamp at right), and to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  3. Electrostatic Levitator Vacuum Chambers

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical prots ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (the beam passes through the window at left), poisitioning lasers (one port is at center), and lamps (such as the deuterium arc lamp at right), and to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  4. Electrostatic Levitator Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Optical prots ring the Electrostatic Levitator (ESL) vacuum chamber to admit light from the heating laser (the beam passes through the window at left), poisitioning lasers (one port is at center), and lamps (arc lamp at right), and to allow diagnostic instruments to view the sample. The ESL uses static electricity to suspend an object (about 2-3 mm in diameter) inside a vacuum chamber while a laser heats the sample until it melts. This lets scientists record a wide range of physical properties without the sample contacting the container or any instruments, conditions that would alter the readings. The Electrostatic Levitator is one of several tools used in NASA's microgravity materials science program.

  5. Left hemiparalexia.

    PubMed

    Binder, J R; Lazar, R M; Tatemichi, T K; Mohr, J P; Desmond, D W; Ciecierski, K A

    1992-03-01

    Three patients with left splenial lesions made paralexic errors restricted to the left end of words. Errors appeared more frequently when a correct response was highly dependent on the initial letter of the stimulus. One patient had full visual fields with hemialexia affecting the left visual field. The other two patients had complete right hemianopia. We attribute left-sided reading errors in the hemianopic patients to a retinotopically restricted disconnection pattern that selectively disrupts transfer of information originating from the peripheral left visual field. Functional resistance of the more numerous transcallosal projections representing visual field adjacent to the vertical meridian may account for such a pattern. The emergence of positional reading errors from retinotopically restricted left hemifield disconnection suggests that callosal information transfer during normal reading may primarily involve elemental sensory rather than lexical/semantic information. PMID:1307679

  6. Cardiac mechanics: Physiological, clinical, and mathematical considerations

    NASA Technical Reports Server (NTRS)

    Mirsky, I. (editor); Ghista, D. N.; Sandler, H.

    1974-01-01

    Recent studies concerning the basic physiological and biochemical principles underlying cardiac muscle contraction, methods for the assessment of cardiac function in the clinical situation, and mathematical approaches to cardiac mechanics are presented. Some of the topics covered include: cardiac ultrastructure and function in the normal and failing heart, myocardial energetics, clinical applications of angiocardiography, use of echocardiography for evaluating cardiac performance, systolic time intervals in the noninvasive assessment of left ventricular performance in man, evaluation of passive elastic stiffness for the left ventricle and isolated heart muscle, a conceptual model of myocardial infarction and cardiogenic shock, application of Huxley's sliding-filament theory to the mechanics of normal and hypertrophied cardiac muscle, and a rheological modeling of the intact left ventricle. Individual items are announced in this issue.

  7. Beat?to?Beat Spatiotemporal Variability in the T Vector Is Associated With Sudden Cardiac Death in Participants Without Left Ventricular Hypertrophy: The Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Waks, Jonathan W.; Soliman, Elsayed Z.; Henrikson, Charles A.; Sotoodehnia, Nona; Han, Lichy; Agarwal, Sunil K.; Arking, Dan E.; Siscovick, David S.; Solomon, Scott D.; Post, Wendy S.; Josephson, Mark E.; Coresh, Josef; Tereshchenko, Larisa G.

    2015-01-01

    Background Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed. Methods and Results Beat?to?beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T?wave vectors (mean TT? angle) on standard 12?lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ?120 ms were excluded. The mean spatial TT? angle was 5.21±3.55°. During a median of 14 years of follow?up, 235 SCDs occurred (1.24 per 1000 person?years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT? angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT? angle >90th percentile (>9.57°) was associated with a 2?fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T?vector amplitude ?0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT? angle and age was found: TT? angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ?55 years (Pinteraction=0.009). Conclusions In a large, prospective, community?based cohort of left ventricular hypertrophy–free participants, increased beat?to?beat spatiotemporal variability in the T vector, as assessed by increasing TT? angle, was associated with SCD. PMID:25600143

  8. Nongated cardiac magnetic resonance imaging: preliminary experience at 0. 12 T

    SciTech Connect

    Choyke, P.L.; Kressel, H.Y.; Reichek, N.; Axel, L.; Gefter, W.; Mamourian, A.C.; Thickman, D.

    1984-12-01

    Nongated cardiac magnetic resonance imaging (MRI) has been reported previously to be inadequate for obtaining diagnostic information. This study explored the role of pulse sequence in the degradation of the nongated cardiac image. Images of diagnostic quality were obtained by using single spin-echo sequences with a very short echo time (10-20 msec TE) on a 0.12-T development MR unit. Marked degradation of the image was noted with longer TEs. Short-TE technique was used to examine 34 patients with a variety of cardiac diseases. Eleven patients had ventricular aneurysms. Twenty patients had left ventricular hypertrophy that was concentric in 11. Six patients had extrinsic masses displacing the heart and distorting the chamber contour. One patient with ventricular septal defect (VSD) and corrected transposition was scanned. In addition to identifying the VSD and chamber hypertrophy, the malposition of the great vessels at the base of the heart was seen. Four postoperative patients were scanned; wire suture artifact did not preclude imaging. In conclusion, diagnostic information can be obtained from nongated cardiac images provided that the TE is very short (10-20 msec). Although quantitative functional data are not available from nongated images, qualitative and diagnostic information is possible and may suffice in certain circumstances.

  9. Left atrial band: a rare congenital anomaly.

    PubMed

    Liou, Kevin; Premaratne, Manuja; Mathur, Gita

    2014-01-01

    Left atrial fibromuscular band is a rare congenital cardiac anomaly. We present a patient with an incidental finding of left atrial band on an intra-operative transesophageal echocardiogram and characterize its appearance on two-dimensional and three-dimensional echocardiograms. PMID:25281635

  10. Cardiac metabolism and arrhythmias

    PubMed Central

    Barth, Andreas S; Tomaselli, Gordon F

    2009-01-01

    Sudden cardiac death remains a leading cause of mortality in the Western world, accounting for up to 20% of all deaths in the U.S.1, 2 The major causes of sudden cardiac death in adults age 35 and older are coronary artery disease (70–80%) and dilated cardiomyopathy (10–15%).3 At the molecular level, a wide variety of mechanisms contribute to arrhythmias that cause sudden cardiac death, ranging from genetic predisposition (rare mutations and common polymorphisms in ion channels and structural proteins) to acquired electrophysiological and structural remodeling in left ventricular hypertrophy and failure.4, 5 A growing body of evidence suggests that altered ion channel function is closely linked to changes in metabolic activity in a wide variety of pathological conditions. In this review we focus on the mechanisms by which altered metabolic function impacts cardiac electrophysiology. We will review the specific molecular targets that allow cardiomyocytes to recognize alterations in their metabolic state and translate this information into changes in membrane excitability in various pathophysiological conditions including ischemia-reperfusion, heart failure (HF), left ventricular hypertrophy, diabetic cardiomyopathy and atrial fibrillation. A comprehensive understanding of the interrelated processes of metabolic and electrical remodeling promises to identify new molecular targets for the treatment of cardiac arrhythmias. PMID:19808483

  11. RIGHT AND LEFT VENTRICULAR DIASTOLIC PRESSURE–VOLUME RELATIONS: A COMPREHENSIVE REVIEW

    PubMed Central

    Pasipoularides, Ares

    2012-01-01

    Ventricular compliance alterations can affect cardiac performance and adaptations. Moreover, diastolic mechanics are important in assessing both diastolic and systolic function, since any filling impairment can compromise systolic function. A sigmoidal passive filling pressure-volume relationship, developed using chronically instrumented, awake-animal disease models, is clinically adaptable to evaluating diastolic dynamics using subject-specific micromanometric and volumetric data from the entire filling period of any heartbeat(s). This innovative relationship is the global, integrated expression of chamber geometry, wall thickness, and passive myocardial wall properties. Chamber and myocardial compliance curves of both ventricles can be computed by the sigmoidal methodology over the entire filling period and plotted over appropriate filling pressure ranges. Important characteristics of the compliance curves can be examined and compared between the right and the left ventricle, and for different physiological and pathological conditions. The sigmoidal paradigm is more accurate and, therefore, a better alternative to the conventional exponential pressure-volume approximation. PMID:23179133

  12. Haemodynamic benefit of a rate-adapted A-V delay in dual chamber pacing.

    PubMed

    Ritter, P; Daubert, C; Mabo, P; Descaves, C; Gouffault, J

    1989-07-01

    In dual chamber pacing, an improvement of exercise capacity is expected when the atrial refractory period is shortened, because the 2/1 point is increased. This objective can be achieved by greatly reducing atrioventricular delay (AVD) on exercise. Are such variations (up to 100-120 ms) detrimental from a haemodynamic standpoint? This study was performed to analyse this particular aspect of DDD pacing. Three DDD pacing modes, differing by their AVDs (fixed 200 ms AVD, fixed 150 ms AVD, and rate-adapted AVD) were tested in random order, with a haemodynamic protocol including ten patients with chronic atrio-ventricular (A-V) block. For the rate-adapted AVD pacing mode, AVD was reduced by 20 ms every 10 beats min-1 increment (from 220 ms at 90 beats min-1 to 100 ms at 150 beats min-1). Pacing rate was increased from 90 to 150 beats min-1 by increments of 10 beats min-1 every 5 min. Cardiac performance was significantly improved with the rate-adapted AVD above the two fixed AVDs, despite a large AVD variation. When AVD was rate adapted, cardiac index, stroke volume index and left ventricular systolic work index were generally higher and pulmonary capillary wedge pressure, pulmonary arterial pressure and systemic vascular resistances were generally lower, especially at 120, 130 and 140 beats min-1. Comparing the two fixed AVDs, 200 AVD improved cardiac function more at lower heart rates, whereas 150 AVD improved cardiac function more at higher heart rates. Despite its limitations, this study demonstrates that the potential benefits of reducing AVD with increasing heart rates should be twofold in dual chamber pacing: (a) haemodynamic, optimizing cardiac performance on exercise for all heart rates, especially in cases of organic heart disease; (b) electrophysiologic, permitting a sufficiently rapid maximal tracking rate in cases with long post-ventricular atrial refractory periods, allowing a satisfactory level of exercise. PMID:2767075

  13. Comparison of morphological and functional adaptations of the heart in highly trained triathletes and long-distance runners using cardiac magnetic resonance imaging.

    PubMed

    Franzen, Erik; Mangold, Stefanie; Erz, Gunnar; Claussen, Claus D; Niess, Andreas M; Kramer, Ulrich; Burgstahler, Christof

    2013-09-01

    "Athlete's heart" is characterized by an increase in ventricular chamber sizes and myocardial mass (MM), and is mainly observed in endurance athletes. At present, it remains unclear whether cardiac adaptations in long-distance runners differ from those in triathletes. Twenty male triathletes (mean age 38.7 ± 6.2 years) and 20 male marathon runners (mean age 44.1 ± 7.9) underwent cardiac magnetic resonance imaging to calculate left and right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and MM. Late-enhancement (LE) imaging was used to exclude structural alterations or myocardial scarring. EDV, ESV, SV, and EF for the left and right ventricles, as well as MM, did not differ between long-distance runners and triathletes, although the weekly training volume was significantly higher in triathletes (17.05 vs 9.95 h/week, P < 0.0001). There was a significant correlation between weekly training volume and right and left EDV, right and left ESV as well as MM within the study group. Myocardial LE was absent in all athletes. Highly trained male long-distance runners and triathletes have comparable cardiac parameters. However, the extent of physical training seems to be associated with the degree of cardiac adaptation in endurance athletes. The absence of LE supports the idea that athlete's heart is a nonpathological adaptation of the cardiovascular system. PMID:22983606

  14. Fluid-dynamics modelling of the human left ventricle with dynamic mesh for normal and myocardial infarction: preliminary study.

    PubMed

    Khalafvand, S S; Ng, E Y K; Zhong, L; Hung, T K

    2012-08-01

    Pulsating blood flow patterns in the left ventricular (LV) were computed for three normal subjects and three patients after myocardial infarction (MI). Cardiac magnetic resonance (MR) images were obtained, segmented and transformed into 25 frames of LV for a computational fluid dynamics (CFD) study. Multi-block structure meshes were generated for 25 frames and 75 intermediate grids. The complete LV cycle was modelled by using ANSYS-CFX 12. The flow patterns and pressure drops in the LV chamber of this study provided some useful information on intra-LV flow patterns with heart diseases. PMID:22795507

  15. Temporary left heart bypass and total artificial replacement.

    PubMed

    Bücherl, E S

    1985-01-01

    Research into left heart assistance was initiated in Berlin in the 1960s with a small implantable pump between the left atrium and the aorta with an extracorporeal driving unit. From thereon, different blood pumps were developed from different materials, the latest types being made out of polyurethanes. Similar designs are used for the total artificial heart. Longest function times exceed 200 days, partly with problems similar to those of the artificial heart. Total artificial heart research began in 1962. The present system consists of 2 polyurethane blood pumps divided by 3 membranes into blood and energy transmission chambers. The longest testing function time is now more than 2 years. The outside driving units of different sizes and designs are connected with tubes and special quick connectors to the right and left atrium, aorta and pulmonary artery. Air capsulae for pressure measurements are incorporated. In addition to all the interesting hemodynamic parameters a great deal of analysis on hematology, biochemistry and metabolic function has been done. The longest survival time in animals is over 200 days. Complications and problems are mostly due to the material, in which small lesions, cracks or slight flaws in fabrication or biodegradation are the starting point for thrombosis and later on calcification. The number of patients who should be given temporary cardiac assistance or total replacement is discussed. PMID:3913182

  16. Optimal carbon dioxide application for organ protection in cardiac surgery

    Microsoft Academic Search

    S. Martens; M. Dietrich; G. Wimmer-Greinecker; A. Moritz

    2002-01-01

    Background: Cardiac surgery is associated with an important risk of central or peripheral organ damage, attributed in part to air embolism from incompletely deaired cardiac chambers. Insufflation of carbon dioxide into the thoracic cavity is widely used for organ protection in cardiac surgery. Methods: In patients operated on through a sternotomy, the gas was insufflated through a standard cardioplegia line

  17. Fibroblast-mediated pathways in cardiac hypertrophy.

    PubMed

    Fujiu, Katsuhito; Nagai, Ryozo

    2014-05-01

    Under normal physiological conditions, cardiac fibroblasts are the primary producers of extracellular matrix and supply a mechanical scaffold for efficacious heart contractions induced by cardiomyocytes. In the hypertrophic heart, cardiac fibroblasts provide a pivotal contribution to cardiac remodeling. Many growth factors and extracellular matrix components secreted by cardiac fibroblasts induce and modify cardiomyocyte hypertrophy. Recent evidence revealed that cardiomyocyte-cardiac fibroblast communications are complex and multifactorial. Many growth factors and molecules contribute to cardiac hypertrophy via different roles that include induction of hypertrophy and the feedback hypertrophic response, fine-tuning of adaptive hypertrophy, limitation of left ventricular dilation, and modification of interstitial changes. This review focuses on recent work and topics and provides a mechanistic insight into cardiomyocyte-cardiac fibroblast communication in cardiac hypertrophy. This article is part of a Special Issue entitled "Myocyte-Fibroblast Signalling in Myocardium ". PMID:24492068

  18. Cardiac Amyloidosis

    MedlinePLUS

    ... pdf/view ). Previous Section Next Section Sources of Funding Dr Quarta received funding from the “Istituto Nazionale per le Ricerche Cardiovascolari ( ... Women's Hospital Cardiac Amyloidosis Fund. Dr Falk received funding from the Brigham and Women's Hospital Cardiac Amyloidosis ...

  19. [Open heart radio frequency left atrial compartmentation during mitral valve surgery: an alternative to the labyrinth procedure?].

    PubMed

    Schläpfer, J; Ruchat, P; Delabays, A; Hurni, M; Milne, J; von Segesser, L K

    2002-04-01

    The authors report their experience of radiofrequency left atrial compartimentation during open heart mitral valve surgery on 37 patients with a 42 +/- 12 months history of atrial fibrillation. The preoperative left ventricular ejection fraction was 62 +/- 8%; the left atrial diameter was 59 +/- 11 mm. The mean operative time was 245 +/- 60 minutes, which included 19 +/- 5 minutes for the ablation procedure. There were 2 early postoperative deaths and 2 deaths from non-cardiac causes at 3 and 6 months. The left ventricular ejection fraction and left atrial dimension were significantly decreased at the time of hospital discharge (54 +/- 12% and 51 +/- 7 mm respectively) (p < 0.01). After an average follow-up of 1 year, 81% of patients were free of atrial fibrillation: 6 patients had undergone DC cardioversion and 1 had a dual-chamber pacemaker. Patients in sinus rhythm after the ablation were associated with shorter periods of atrial fibrillation and smaller left atrial dimensions postoperatively than those who remained in fibrillation. The authors conclude that radiofrequency compartimentation of the left atrium associated with antiarrhythmic therapy can interrupt atrial fibrillation in 81% of patients at 1 year: the ablation procedure takes only 8% of the operation time. Predictive factors of success of ablation should be defined to determine which patients benefit most from this technique. PMID:12055767

  20. Cardiac regeneration in children.

    PubMed

    Rupp, Stefan; Schranz, Dietmar

    2015-04-01

    Very young mammals have an impressive cardiac regeneration capacity. In contrast, cardiac regeneration is very limited in adult humans. The hearts of young children have a higher regenerative capacity compared with adults, as, for example, seen after surgical correction of an anomalous left coronary artery arising from the pulmonary artery or in children with univentricular hearts, who present enormous morphological changes after volume unloading. In addition, the enormous regenerative potential of growing children's hearts is reflected in the spontaneous courses of children with severely deteriorated cardiac function (e.g., patients with dilated cardiomyopathy). The extent of this regenerative capacity and its time dependency remain to be elucidated in the future and should be exploited to improve the treatment of children with severe heart insufficiency. PMID:25633820

  1. Malignant phyllodes tumor of the left atrium

    PubMed Central

    Bhambhani, Anupam; Ayyagari, Sudha; Mohapatra, Tushar; Rehman, Syed Abdul; Shah, Milap; Rao, Sudhakar; Rangashamanna, Vital; Rajasekhar, V.; Chittimilla, Santosh

    2014-01-01

    Metastatic tumors to the heart usually involve right sided chambers. We report a rare case of malignant phyllodes tumor of breast with metastatic involvement of left atrium occurring through direct invasion from mediastinal micro-metastasis and presenting as a left atrial mass causing arrhythmia. PMID:24814127

  2. Malignant phyllodes tumor of the left atrium.

    PubMed

    Bhambhani, Anupam; Ayyagari, Sudha; Mohapatra, Tushar; Rehman, Syed Abdul; Shah, Milap; Rao, Sudhakar; Rangashamanna, Vital; Rajasekhar, V; Chittimilla, Santosh

    2014-01-01

    Metastatic tumors to the heart usually involve right sided chambers. We report a rare case of malignant phyllodes tumor of breast with metastatic involvement of left atrium occurring through direct invasion from mediastinal micro-metastasis and presenting as a left atrial mass causing arrhythmia. PMID:24814127

  3. Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model

    Microsoft Academic Search

    Jie Lian; Garth Garner; Hannes Krätschmer; Dirk Müssig

    2009-01-01

    Long term right ventricular apical pacing has been known to have adverse effects in cardiac function. The AV hysteresis (AVH) is a feature existing in many dual-chamber cardiac pacemakers that aims to minimize the right ventricular pacing, but its clinical efficacy remains inconclusive due to conflicting evidence from different studies. We have recently developed a novel integrated dual-chamber heart and

  4. Videoscope-assisted cardiac surgery

    PubMed Central

    Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader’s further understanding of the topic. PMID:24455172

  5. Two chamber reaction furnace

    Microsoft Academic Search

    Blaugher; Richard D

    1998-01-01

    A vertical two chamber reaction furnace. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber.

  6. Left main coronary artery compression by a left sinus of Valsalva aneurysm

    PubMed Central

    Martínez-Comendador, José; Gualis, Javier; Martín, Carlos Esteban; Santamaria, Alberto

    2013-01-01

    Myocardial ischaemia due to extrinsic left main coronary artery compression is unusual. Most cases are related to pulmonary hypertension with severe main pulmonary artery dilatation. An extremely rare cause is a left sinus of Valsalva aneurysm (SVA). We describe the case of a patient diagnosed of left SVA after a coronary angiography and aortography, whose initial clinical manifestation was an acute coronary syndrome complicated with an out-hospital resuscitated sudden cardiac death. PMID:23355647

  7. [Cardiac sarcoidosis].

    PubMed

    Uemura, Akihisa; Morimoto, Shin-ichiro

    2002-09-01

    Cardiac sarcoidosis induces heart failure death or sudden death in many cases and is thus often associated with a poor prognosis. In Japan 47-78% of sarcoidosis patients die of cardiac lesions. Early diagnosis is important in such cases, and a comprehensive judgment based on the endomyocardial biopsy, echocardiography and nuclear medicine examination findings should be made according to the 'Handbook of the Diagnosis of Cardiac Sarcoidosis'. Once a diagnosis is made the introduction of steroid therapy should be considered. Steroid administration should be conducted referring to the 'Guidelines to the Treatment of Cardiac Sarcoidosis'. PMID:12233077

  8. Two chamber reaction furnace

    Microsoft Academic Search

    Blaugher

    1998-01-01

    A vertical two chamber reaction furnace is described. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the

  9. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    PubMed Central

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; de Paola, Angelo Amato Vincenzo; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-01-01

    Background Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy. PMID:25590933

  10. [Modifications of the left ventricular function as the result of severe and chronic reduction of the preload].

    PubMed

    Alcocer Díaz, L; Arce Gómez, E

    1976-01-01

    In order to evaluate the effect which the cronic, severe, and constant decrease of the preload of the left ventricle has on the contractile function of this chamber, 15 cases, with the strict technical conditions and permitted the planned measurements, were taken from 86 studies of ventricular function in patients with tight mitral stenosis. The following parameters were calculated; the ejection fraction, the maximum DP/dt, the zero point diastolic pressure, the final diastolic pressure, the diastolic AP, the mid-diastolic pressure, the diastolic compliance index, and the passive elastic module of the left ventricle, the pulmonary pressure, the cardiac output, systolic output, and the changes produced by the infusion of Isopropilaminoetanol. It was concluded that the effects of cronic and severe pre-load decrease are: 1. Moderate decrease of the cardiac output with low systolic output and high cardiac frequency. 2. Conserved inotropic reserve. 3. Normal ejection fraction. 4. Normal diastolic tension behavior. 5. Increased compliance and special behavior of the passive elastic module. PMID:984955

  11. An integrated platform for image-guided cardiac resynchronization therapy

    NASA Astrophysics Data System (ADS)

    Ma, Ying Liang; Shetty, Anoop K.; Duckett, Simon; Etyngier, Patrick; Gijsbers, Geert; Bullens, Roland; Schaeffter, Tobias; Razavi, Reza; Rinaldi, Christopher A.; Rhode, Kawal S.

    2012-05-01

    Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7 mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets by computing the registration error of the LV pacing lead electrodes which was found to be 2.2 ± 0.9 mm. Furthermore, the use of Unfold Navigation was demonstrated in real-time for four clinical cases.

  12. Left Ventricular Pseudoaneurysm after Valve Replacement

    PubMed Central

    Lee, Jun Ho; Jeon, Seok Chol; Jang, Hyo-Jun; Chung, Won-Sang; Kim, Young Hak; Kim, Hyuck

    2015-01-01

    We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy. PMID:25705601

  13. Study of cardiac ejection fraction and volume measurements using a dynamic cardiac phantom and SPECT

    Microsoft Academic Search

    S. Jang; Ronald J. Jaszczak; Jianying Li; J. F. Debatin; Scott N. Nadel; A. J. Evans; K. L. Greer; R. E. Coleman

    1993-01-01

    A dynamic cardiac phantom and single photon emission computed tomography (SPECT) imaging were used to obtain ejection fraction (EF) and left ventricular volume measurements. The dynamic cardiac phantom consists of two ventricles with a volume of approximately 58 ml each at 1 atm. pressure. This latex and rubber-foam phantom was connected to a pulsatile flow pump via noncompliant plastic tubing.

  14. A multimodal (MRI/ultrasound) cardiac phantom for imaging experiments

    NASA Astrophysics Data System (ADS)

    Tavakoli, Vahid; Kendrick, Michael; Shakeri, Mostafa; Alshaher, Motaz; Stoddard, Marcus F.; Amini, Amir

    2013-03-01

    A dynamic cardiac phantom can play a significant role in the evaluation and development of ultrasound and cardiac magnetic resonance (MR) motion tracking and registration methods. A four chamber multimodal cardiac phantom has been designed and built to simulate normal and pathologic hearts with different degrees of "infarction" and "scar tissues". In this set up, cardiac valves have been designed and modeled as well. The four-chamber structure can simulate the asymmetric ventricular, atrial and valve motions. Poly Vinyl Alcohol (PVA) is used as the principal material since it can simulate the shape, elasticity, and MR and ultrasound properties of the heart. The cardiac shape is simulated using a four-chamber mold made of polymer clay. An additional pathologic heart phantom containing stiff inclusions has been manufactured in order to simulate an infracted heart. The stiff inclusions are of different shapes and different degrees of elasticity and are able to simulate abnormal cardiac segments. The cardiac elasticity is adjusted based on freeze-thaw cycles of the PVA cryogel for normal and scarred regions. Ultrasound and MRI markers were inserted in the cardiac phantom as landmarks for validations. To the best of our knowledge, this is the first multimodal phantom that models a dynamic four-chamber human heart including the cardiac valve.

  15. Concrete induced cardiac contusion.

    PubMed

    Curzen, N; Brett, S; Fox, K

    1997-09-01

    A previously fit 22 year old man was struck in the chest by a concrete block dropped through the windscreen of his car while he was driving on the motorway. He suffered extensive chest wall trauma and lung contusion, which subsequently precipitated acute respiratory distress. On admission ECG showed right bundle branch block and left axis deviation. Three days later QRS duration was normal but there was anterior ST segment elevation and subsequent T wave change. There was a large rise in creatine kinase, and echocardiography revealed septal and apical hyokinesis as well as a mobile mass attached to the left side of the interventricular septum, which had the echogenic texture of myocardium. The patient had fixed perfusion defects in the areas of hypokinesis on thallium scanning but the coronary arteries were unobstructed at angiography. He was treated with warfarin in the short term and an angiotensin converting enzyme inhibitor in the longer term and has made an asymptomatic recovery. Outpatient echocardiography two months after the injury demonstrated some recovery in overall left ventricular systolic function and no evidence of the intracardiac mass. This case illustrates some of the typical features of non-fatal cardiac contusion associated with non-penetrating cardiac trauma, and was complicated by partial thickness avulsion of a strip of the myocardium in the interventricular septum. PMID:9391297

  16. Intravenous Angiocardiography Using Digital Image Processing: Experience With Axial Projections In Normal Pigs And In Pigs With Experimentally Generated Left-To-Right Shunts

    NASA Astrophysics Data System (ADS)

    Bogren, Hugo G.; Bursch, Joachim H.; Brennecke, Rudiger; Heintzen, Paul H.

    1981-11-01

    Computerized digitization and processing of roentgen video images recorded at a rate of 50 per second was tested in intravenous angiocardiography in normal pigs weighing 15 to 20 kg. Roentgen video images were recorded in the 4-chamber view obtained by 30-35 degrees caudocranial angulation of the x-ray tube and 50-60 degrees LAO obliquity in the pig. Significant contrast enhancement was obtained through ECG-gated background subtraction and rescaling after integration of multiple background as well as contrast images. Occasionally, histogram equalization was used to further enhance contrast. To study temporal changes in cardiac motion, time parameter extraction or functional imaging was applied as well. The left and right heart were well visualized after intravenous injection of 1/3-1 cc. 76% Urografin per kg. bodyweight. Special purpose processing like subtraction of the end systolic phase from the end diastolic in the left and right ventricles as well as subtraction of the right ventricular phase from the left ventricular phase was also performed. If the left ventricular end systolic phase was subtracted from the end diastolic, most of the left atrium was also subtracted whereby the left ventricle was seen without continuity or superimposition of the left atrium. Experimentally generated ventricular and atrial septal defects as well as patent ductus arteriosus could be detected using the described technique. The results of the animal experiments became the basis for subsequent applications in children with congenital heart disease.

  17. Cardiac nuclear medicine

    SciTech Connect

    Gerson, M.C.

    1987-01-01

    The book begins with a review of the radionuclide methods available for evaluating cardiac perfusion and function. The authors discuss planar and tomographic thallium myocardial imaging, first-pass and equilibrium radionuclide angiography, and imaging with infarct-avid tracers. Several common but more specialized procedures are then reviewed: nonogemetric measurement of left ventricular volume, phase (Fourier) analysis, stroke volume ratio, right ventricular function, and diastolic function. A separate chapter is devoted to drug interventions and in particular the use of radionuclide ventriculography to monitor doxorubicin toxicity and therapy of congestive heart failure. The subsequent chapters provide a comprehensive guide to test selection, accuracy, and results in acute myocardial infarction, in postmyocardial infarction, in chronic coronary artery disease, before and after medical or surgical revascularization, in valvular heart disease, in cardiomyopathies, and in cardiac trauma.

  18. Primary cardiac lipoblastoma.

    PubMed

    Dishop, M K; O'Connor, W N; Abraham, S; Cottrill, C M

    2001-01-01

    Lipoblastoma is a benign adipose tumor in children that has been described in various anatomic locations, most commonly the extremities. We describe the case of a 17-month-old boy diagnosed with cardiac lipoblastoma, a previously unreported primary cardiac tumor in children. Our patient presented with symptoms of coughing, wheezing, and hoarseness and was found to have a large mediastinal mass, which narrowed the left mainstem bronchus and compressed the right atrium and superior vena cava, causing superior vena cava syndrome. Surgical exploration revealed an intrapericardial soft tissue mass arising from the area of the posterior interatrial septum. Grossly, the resected mass was lobulated, pale yellow, and fatty with focal areas of gray myxoid tissue. Microscopically, the tumor consisted of both immature and mature adipocytes, with focal vascular myxoid areas containing lipoblasts, diagnostic of lipoblastoma. Two months after surgery, the patient was in good health without evidence of recurrence. PMID:11370265

  19. Gender Differences in Postinfarction Left Ventricular Remodeling

    Microsoft Academic Search

    Sheldon E. Litwin; Sarah E. Katz; Christine M. Litwin; James P. Morgan; Pamela S. Douglas

    1999-01-01

    Objective: Previous studies suggest that gender affects the adaptive responses of the heart to some forms of cardiac overload. It is unknown whether gender influences left ventricular (LV) remodeling after myocardial infarction (MI). Methods: We performed transthoracic echocardiographic-Doppler examinations in age-matched male (n = 17) and female (n = 16) rats before, and 1 and 6 weeks after transmural MI

  20. Rituximab Induced Left Bundle Branch Block

    PubMed Central

    Sheikh, Mujeeb; Moza, Ankush; Grubb, Blair P.

    2015-01-01

    Rituximab (a monoclonal antibody directed against CD 20) therapy can be acutely complicated by infusion reactions and cardiac arrhythmia on rare occasions. We report the first case of a new onset left bundle branch block (LBBB) after rituximab therapy for Wegener's vasculitis.

  1. Permanent cardiac pacing in pediatric patients.

    PubMed

    Lotfy, Wael; Hegazy, Ranya; AbdElAziz, Osama; Sobhy, Rodina; Hasanein, Hossam; Shaltout, Fawzan

    2013-02-01

    Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow-up assessment is needed for further evaluation. PMID:22886361

  2. REGIONAL CHANGES IN CARDIAC AND STELLATE GANGLION NOREPINEPHRINE TRANSPORTER IN DOCA-SALT HYPERTENSION

    PubMed Central

    Wehrwein, Erica A.; Novotny, Martin; Swain, Greg M.; Parker, Lindsay M.; Esfahanian, Mohammad; Spitsbergen, John M.; Habecker, Beth A.; Kreulen, David L.

    2013-01-01

    Uptake of norepinephrine via the neuronal norepinephrine transporter is reduced in the heart during deoxycorticosterone (DOCA)-salt hypertension. We hypothesized that this was due to reduced norepinephrine transporter mRNA and/or protein expression in the stellate ganglia and heart. After 4-weeks of DOCA-salt treatment there was no change in norepinephrine transporter mRNA in either the right or the left stellate ganglia from hypertensive rats (n=5–7, p>0.05). Norepinephrine transporter immunoreactivity in the left stellate ganglion was significantly increased (n=4, p<0.05) while the right stellate ganglion was unchanged (n=4, p>0.05). Whole heart norepinephrine content was significantly reduced in DOCA rats consistent with reduced uptake function; however, when norepinephrine was assessed by chamber, a significant decrease was noted only in the right atrium and right ventricle (n=6, p<0.05). Cardiac norepinephrine transport binding by chamber revealed that it was only reduced in the left atrium (n=5–7, p>0.05). Therefore, 1) contrary to our hypothesis reduced reuptake in the hypertensive heart is not exclusively due to an overall reduction in norepinephrine transporter mRNA or protein in the stellate ganglion or heart, and 2) norepinephrine transporter regulation occurs regionally in the heart and stellate ganglion in the hypertensive rat heart. PMID:24075956

  3. A novel passive left heart platform for device testing and research.

    PubMed

    Leopaldi, A M; Vismara, R; van Tuijl, S; Redaelli, A; van de Vosse, F N; Fiore, G B; Rutten, M C M

    2015-04-01

    Integration of biological samples into in vitro mock loops is fundamental to simulate real device's operating conditions. We developed an in vitro platform capable of simulating the pumping function of the heart through the external pressurization of the ventricle. The system consists of a fluid-filled chamber, in which the ventricles are housed and sealed to exclude the atria from external loads. The chamber is connected to a pump that drives the motion of the ventricular walls. The aorta is connected to a systemic impedance simulator, and the left atrium to an adjustable preload. The platform reproduced physiologic hemodynamics, i.e. aortic pressures of 120/80 mmHg with 5 L/min of cardiac output, and allowed for intracardiac endoscopy. A pilot study with a left ventricular assist device (LVAD) was also performed. The LVAD was connected to the heart to investigate aortic valve functioning at different levels of support. Results were consistent with the literature, and high speed video recordings of the aortic valve allowed for the visualization of the transition between a fully opening valve and a permanently closed configuration. In conclusion, the system showed to be an effective tool for the hemodynamic assessment of devices, the simulation of surgical or transcatheter procedures and for visualization studies. PMID:25666402

  4. Cardiac factors in orthostatic hypotension

    NASA Astrophysics Data System (ADS)

    Löllgen, H.; Dirschedl, P.; Koppenhagen, K.; Klein, K. E.

    Cardiac function is determined by preload, afterload, heart rate and contractility. During orthostatic stress, the footward blood shift is compensated for by an increase of afterload. LBNP is widely used to analyze effects of volume displacement during orthostatic stress. Comparisons of invasive ( right heart catheterization) and non-invasive approach (echocardiography) yielded similar changes. Preload and afterload change with graded LBNP, heart rate increases, and stroke volume and cardiac output decrease. Thus, the working point on the left ventricular function curve is shifted to the left and downward, similar to hypovolemia. However, position on the Frank-Starling curve, the unchanged ejection fraction, and the constant Vcf indicate a normal contractile state during LBNP. A decrease of arterial oxygen partial pressure during LBNP shwos impaired ventilation/perfusion ratio. Finally, LBNP induced cardiac and hemodynamic changes can be effectively countermeasured by dihydroergotamine, a potent venoconstrictor. Comparison of floating catheter data with that of echocardiography resulted in close correlation for cardiac output and stroke volume. In addition, cardiac dimensions changed in a similar way during LBNP. From our findings, echocardiography as a non-invasive procedure can reliably used in LBNP and orthostatic stress tests. Some informations can be obtained on borderline values indicating collaps or orthostatic syncope. Early fainters can be differentiated from late fainters by stroke volume changes.

  5. Cardiac outflow tract anomalies

    PubMed Central

    Neeb, Zachary; Lajiness, Jacquelyn D.; Bolanis, Esther; Conway, Simon J

    2014-01-01

    The mature outflow tract (OFT) is, in basic terms, a short conduit. It is a simple, although vital, connection situated between contracting muscular heart chambers and a vast embryonic vascular network. Unfortunately, it is also a focal point underlying many multifactorial congenital heart defects (CHDs). Through the use of various animal models combined with human genetic investigations, we are beginning to comprehend the molecular and cellular framework that controls OFT morphogenesis. Clear roles of neural crest cells (NCC) and second heart field (SHF) derivatives have been established during OFT formation and remodeling. The challenge now is to determine how the SHF and cardiac NCC interact, the complex reciprocal signaling that appears to be occurring at various stages of OFT morphogenesis, and finally how endocardial progenitors and primary heart field (PHF) communicate with both these colonizing extra-cardiac lineages. Although we are beginning to understand that this dance of progenitor populations is wonderfully intricate, the underlying pathogenesis and the spatiotemporal cell lineage interactions remain to be fully elucidated. What is now clear is that OFT alignment and septation are independent processes, invested via separate SHF and cardiac neural crest (CNC) lineages. This review will focus on our current understanding of the respective contributions of the SHF and CNC lineage during OFT development and pathogenesis. PMID:24014420

  6. Segmentation of the Left Heart Ventricle in Ultrasound Images Using a Region Based Snake

    E-print Network

    Lunds Universitet

    Segmentation of the Left Heart Ventricle in Ultrasound Images Using a Region Based Snake Matilda that uses a region based snake. To avoid any unwanted concavities in the segmentations due to the cardiac valve we use two anchor points in the snake that are located to the left and to the right of the cardiac

  7. Cardiac Catheterization

    MedlinePLUS

    ... done during a cardiac catheterization include: closing small holes inside the heart repairing leaky or narrow heart ... bandage. It's normal for the site to be black and blue, red, or slightly swollen for a ...

  8. CARDIAC MUSCLE

    PubMed Central

    Jewett, Paul H.; Sommer, J. R.; Johnson, E. A.

    1971-01-01

    Cardiac muscle fibers of the hummingbird and finch have no transverse tubules and are smaller in diameter than those of mammalian hearts. The fibers are connected by intercalated discs which are composed of desmosomes and f. adherentes; small nexuses are often interspersed. As in cardiac muscle of several other animals, the junctional SR of the couplings is highly structured in these two birds but, in addition, and after having lost sarcolemmal contact, the junctional SR continues beyond the coupling to extend deep into the interior of the cells and to form belts around the Z-I regions of the sarcomeres. This portion of the sarcoplasmic reticulum, which we have named "extended junctional SR," and which is so prominent and invariant a feature of cardiac cells of hummingbirds and finches, has not been observed in chicken cardiac cells. The morphological differences between these species of birds may be related to respective differences in heart rates characteristic for these birds. PMID:5555579

  9. Cardiac Aspergillosis

    Microsoft Academic Search

    Philippe Lagacé-Wiens; Ethan Rubinstein

    \\u000a Cardiac aspergillosis has been increasingly recognized as a complication of immunocompromise in recent times. The use of progressively\\u000a more potent immunosuppressive agents and the longer survival times of transplant recipients is likely contributing to an increasing\\u000a prevalence of the disease. Although still uncommon, the disease has an extremely high mortality rate and management remains\\u000a difficult. Cardiac aspergillosis can present as

  10. Nuclear cardiac

    SciTech Connect

    Slutsky, R.; Ashburn, W.L.

    1982-01-01

    The relationship between nuclear medicine and cardiology has continued to produce a surfeit of interesting, illuminating, and important reports involving the analysis of cardiac function, perfusion, and metabolism. To simplify the presentation, this review is broken down into three major subheadings: analysis of myocardial perfusion; imaging of the recent myocardial infarction; and the evaluation of myocardial function. There appears to be an increasingly important relationship between cardiology, particularly cardiac physiology, and nuclear imaging techniques. (KRM)

  11. Cardiac cephalgia.

    PubMed

    Torres-Yaghi, Yasar; Salerian, Justin; Dougherty, Carrie

    2015-04-01

    "Cardiac cephalgia" is a type of secondary headache disorder, usually initiated by exertion that is related to myocardial ischemia. Primary exertional headaches such as sex-, cough-, or exercise-induced headaches are typically benign. Cardiac cephalgia, on the other hand, can have life-threatening complications. Due to overlapping features and similarities in presentation, cardiac cephalgia can be misdiagnosed as a primary headache disorder such as migraine. However, the management of these conditions is unique, and treatment of cardiac cephalgia with vasoconstrictors intended for migraine can potentially worsen myocardial ischemia. Thus, it is important to make the correct diagnosis by evaluating cardiac function with an electrocardiogram and/or stress testing. In this review, we examine reported cases of cardiac cephalgia from the past 5 years to highlight the importance of this condition in the differential diagnosis of a headache in a patient with a history of cardiovascular risk factors, as well as to discuss the appropriate approach to diagnosis and the proposed pathogenic mechanisms of this condition. PMID:25819974

  12. 8. SEDIMENTATION CHAMBER, VIEW UPSTREAM (PLANK COVER REMOVED FOR CLARITY). ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. SEDIMENTATION CHAMBER, VIEW UPSTREAM (PLANK COVER REMOVED FOR CLARITY). BOX FLUME DROPS SLIGHTLY INTO CHAMBER ON LEFT SIDE. CHAMBER IS A SERIES OF BAFFLES DESIGNED TO SLOW THE FLOW OF WATER. FLOW IS REDUCED TO ALLOW PARTICULATES TO SETTLE TO THE BOTTOM. TWO SCREENS (NOT SHOWN) FILTER LARGER DEBRIS. - Kalaupapa Water Supply System, Waikolu Valley to Kalaupapa Settlement, Island of Molokai, Kalaupapa, Kalawao County, HI

  13. A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation in Patients With Moderately Reduced Left Ventricular Ejection Fraction and a Narrow QRS Duration: Study Rationale and Design

    PubMed Central

    ABRAHAM, WILLIAM T.; LINDENFELD, JOANN; REDDY, VIVEK Y.; HASENFUSS, GERD; KUCK, KARL-HEINZ; BOSCARDIN, JOHN; GIBBONS, ROBERT; BURKHOFF, DANIEL

    2015-01-01

    Cardiac contractility modulation (CCM) signals are nonexcitatory electrical signals delivered during the cardiac absolute refractory period that enhance the strength of cardiac muscular contraction. The FIX-HF-5 study was a prospective randomized study comparing CCM plus optimal medical therapy (OMT) to OMT alone that included 428 New York Heart Association (NYHA) functional class III or IV heart failure patients with ejection fraction (EF) ?45% according to core laboratory assessment. The study met its primary safety end point, but did not reach its primary efficacy end point: a responders analysis of changes in ventilatory anaerobic threshold (VAT). However, in a prespecified subgroup analysis, significant improvements in primary and secondary end points, including the responder VAT end point, were observed in patients with EFs ranging from 25% to 45%, who constituted about one-half of the study subjects. We therefore designed a new study to prospectively confirm the efficacy of CCM in this population. A hierarchic bayesian statistical analysis plan was developed to take advantage of the data already available from the first study. In addition, based on technical difficulties encountered in reliably quantifying VAT and the relatively large amount of nonquantifiable studies, the primary efficacy end point was changed to peak VO2, with significant measures incorporated to minimize the influence of placebo effect. In this paper, we provide the details and rationale of the FIX-HF-5C study design to study CCM plus OMT compared with OMT alone in subjects with normal QRS duration, NYHA functional class III or IV, and EF 25%–45%. This study is registered on www.clinicaltrials.gov with identifier no. NCT01381172. PMID:25285748

  14. Old Riverdale Cotton Mill office building on left. The old ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Old Riverdale Cotton Mill office building on left. The old office building has also been used as a starch mixing house. Note entrance to new office building on right - Riverdale Cotton Mill, Office Building, Old, Valley, Chambers County, AL

  15. 12. VIEW, LOOKING SOUTH FROM LEFT TO RIGHT, SHOWING DRESSING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. VIEW, LOOKING SOUTH FROM LEFT TO RIGHT, SHOWING DRESSING FROM AND WORK/CHAMBER ROOM - U.S. Naval Submarine Base, New London Submarine Escape Training Tank, Albacore & Darter Roads, Groton, New London County, CT

  16. 10.1117/2.1200804.1126 euHeart: integrated cardiac care

    E-print Network

    Martin, Ralph R.

    ), congestive heart failure (HF), and cardiac arrhythmias (irregular heart beat). Early de- tection10.1117/2.1200804.1126 euHeart: integrated cardiac care using patient-specific cardiovascular of the heart. (a) Anatomical model of the cardiac chambers, myocardium, and great vessels.7 (b) Patient

  17. Cardiac catheterization is underutilized after in-hospital cardiac arrest

    PubMed Central

    Merchant, Raina M.; Abella, Benjamin S.; Khan, Monica; Huang, Kuang-Ning; Beiser, David B.; Neumar, Robert W.; Carr, Brendan G.; Becker, Lance B.; Vanden Hoek, Terry L.

    2009-01-01

    Background Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival. Methods Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using chi square, and adjusted analyses were performed using logistic regression. Results 110 in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within one day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05). Conclusion In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization. PMID:18951683

  18. An integrated bioimpedance—ECG gating technique for respiratory and cardiac motion compensation in cardiac PET

    NASA Astrophysics Data System (ADS)

    Koivumäki, Tuomas; Nekolla, Stephan G.; Fürst, Sebastian; Loher, Simone; Vauhkonen, Marko; Schwaiger, Markus; Hakulinen, Mikko A.

    2014-10-01

    Respiratory motion may degrade image quality in cardiac PET imaging. Since cardiac PET studies often involve cardiac gating by ECG, a separate respiratory monitoring system is required increasing the logistic complexity of the examination, in case respiratory gating is also needed. Thus, we investigated the simultaneous acquisition of both respiratory and cardiac gating signals using II limb lead mimicking electrode configuration during cardiac PET scans of 11 patients. In addition to conventional static and ECG-gated images, bioimpedance technique was utilized to generate respiratory- and dual-gated images. The ability of the bioimpedance technique to monitor intrathoracic respiratory motion was assessed estimating cardiac displacement between end-inspiration and -expiration. The relevance of dual gating was evaluated in left ventricular volume and myocardial wall thickness measurements. An average 7.6? ± ?3.3?mm respiratory motion was observed in the study population. Dual gating showed a small but significant increase (4?ml, p = 0.042) in left ventricular myocardial volume compared to plain cardiac gating. In addition, a thinner myocardial wall was observed in dual-gated images (9.3? ± ?1.3?mm) compared to cardiac-gated images (11.3? ± ?1.3?mm, p = 0.003). This study shows the feasibility of bioimpedance measurements for dual gating in a clinical setting. The method enables simultaneous acquisition of respiratory and cardiac gating signals using a single device with standard ECG electrodes.

  19. An unusual biatrial cardiac myxoma in a young patient.

    PubMed

    Azari, Ali; Moravvej, Zahra; Chamanian, Soheila; Bigdelu, Leila

    2015-02-01

    This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers' volume. There was no evidence of myxoma recurrence. The most probable cause of the patient's heart failure was considered to be tachycardia-induced cardiomyopathy. PMID:25705602

  20. An Unusual Biatrial Cardiac Myxoma in a Young Patient

    PubMed Central

    Azari, Ali; Moravvej, Zahra; Chamanian, Soheila; Bigdelu, Leila

    2015-01-01

    This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers’ volume. There was no evidence of myxoma recurrence. The most probable cause of the patient’s heart failure was considered to be tachycardia-induced cardiomyopathy. PMID:25705602

  1. Spinal epidural gas after cardiac surgery.

    PubMed

    Yucesoy, K; Cakmakci, H; Naderi, S; Kovanlikaya, A

    2001-02-01

    The authors describe a patient with severe lower back and left leg pain in the early postoperative period after cardiac surgery. Radiologic examination revealed gas in the spinal epidural space at the level of L4-5. The pain could not be relieved with analgesics and the patient underwent lumber surgery after cardiac surgery. After decompression, the patient improved and was discharged with no symptoms. PMID:11242278

  2. What type of different clinical manifestations can cardiac sarcoidosis present?

    PubMed

    Sentürk, Ay?egül; Mara?, Yüksel; Argüder, Emine; Karalezli, Ay?egül; Hasano?lu, H Canan; O?üt, Tuba; Ba?tu?, Serdal; Karabekir, Ercan

    2014-11-28

    Cardiac sarcoidosis is an infiltrative, granulomatous inflammatory disease of the myocardium. Generally, it can be difficult to diagnose cardiac sarcoidosis clinically because of the non-specific nature of its clinical manifestations. This property can be based on the presence of any clinical evidence of sarcoidosis in the other organs. We present two cases of cardiac sarcoidosis so as to demonstrate its different clinical manifestations. The first patient displayed no cardiac symptoms; the electrocardiogram showed an incidental right bundle branch block. Her cardiac magnetic resonance imaging (CMRI) revealed late-phase opaque material enhancement involving the inferior and inferoseptal segment of the left ventricle. The second patient was severely symptomatic in terms of cardiac involvement, and a transthoracic echocardiogram revealed global hypokinesia and septal brightness; his ejection fraction decreased to 45 %. These cases highlighted the challenges encountered in the diagnosis and treatment of cardiac sarcoidosis. CMRI should be considered in all patients who have suspected findings for cardiac involvement. PMID:25429793

  3. Cardiac conditions.

    PubMed

    Peck, Michel D; Ai, Amy L

    2008-01-01

    Cardiovascular disease (CVD) is the leading cause of death in the US. The growth of the older population in coming decades will inevitably increase the incidence of age-related cardiac disease. Increasing evidence has shown the prevalence of co-morbid mental health conditions in CVD patients. Specifically, depression and anxiety have been linked with CVD mortality. Due to the risk of psychosocial conditions with cardiac patients, mental health practitioners in health and gerontology need to be well-informed about CVD-related mental health comorbidity and current research developments. Accordingly, this article provides a systematic review of the clinical evidence about the efficacy, cost-effectiveness, and any potential risk of psychosocial intervention with cardiac patients. PMID:18924386

  4. Cardiac angiosarcoma.

    PubMed

    Ohtahara, A; Hattori, K; Fukuki, M; Hirata, S; Ahmmed, G U; Kato, M; Fujimoto, Y; Shigemasa, C; Mashiba, H

    1996-10-01

    Angiosarcoma is one of the most common cardiac tumors, but early detection of this tumor is often difficult, as exemplified by our patient, a 55-year-old woman whose cardiac tumor was first detected by echocardiography. Surgical removal of the tumor was impossible due to its extensive pericardial invasion. Pathological diagnosis was not complete before autopsy because of the wide occupied necrotized area of the tumor. There is no diagnostic imaging technique available to detect such a necrotized area. An imaging technique more powerful than echocardiography and able to diagnose angiosarcoma earlier is needed. PMID:8933189

  5. Relationship of Exercise Capacity and Left Ventricular Dimensions in Patients with a Normal Ejection Fraction. An Exploratory Study

    PubMed Central

    Nyotowidjojo, Iwan; Chu, Guoxiang; LeWinter, Martin M.

    2015-01-01

    Objectives Extreme endurance exercise is known to be associated with an enlargement of the left ventricular (LV) chamber, whereas inactivity results in inverse changes. It is unknown if these dimensional relationships exist in patients. Methods We analyzed the relationship of exercise capacity and LV dimension in a cohort of sequential patients with a normal ejection fraction undergoing stress echocardiography. In a total of 137 studies the following questions were addressed: (a) is there a difference in LV dimensions of patients with an excellent exercise capacity versus patients with a poor exercise capacity, (b) how is LV dimension and exercise capacity affected by LV wall thickness and (c) how do LV dimensions of patients who are unable to walk on a treadmill compare to the above groups. Results Patients with a poor exercise capacity or who are unable to physically exercise have a 34 percent smaller LV cavity size when compared to patients with an excellent exercise capacity (p<0.001). This reduction in LV chamber size is associated with concentric LV hypertrophy and a reciprocal increase in resting heart rate. In addition, cardiac output reserve is further blunted by chronotropic incompetence and a tachycardia-induced LV volume reduction. In conclusion the relationship of exercise capacity and cardiac dimensions described in extreme athletes also applies to patients. Our exploratory analysis suggests that patients who cannot sufficiently exercise have small LV cavities. PMID:25756359

  6. Two chamber reaction furnace

    DOEpatents

    Blaugher, Richard D. (Evergreen, CO)

    1998-05-05

    A vertical two chamber reaction furnace. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium-copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700.degree. and 800.degree. C.) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800.degree. to 950.degree. C. to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product.

  7. Two chamber reaction furnace

    DOEpatents

    Blaugher, R.D.

    1998-05-05

    A vertical two chamber reaction furnace is described. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium-copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700 C and 800 C) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800 to 950 C to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product. 2 figs.

  8. Racial differences in sudden cardiac death.

    PubMed

    Fender, Erin A; Henrikson, Charles A; Tereshchenko, Larisa

    2014-01-01

    There is an increased risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA), in African Americans, the basis of which is likely multifactorial. African Americans have higher rates of traditional cardiac risk factors including hypertension, left ventricular hypertrophy, diabetes, coronary heart disease, and heart failure. There are also significant disparities in health care delivery. While these factors undoubtedly affect health outcomes, there is also growing evidence that genetics may have a significant impact as well. In this paper, we discuss data and hypotheses in support of both sides of the controversy around racial differences in SCD/SCA. PMID:25155390

  9. Silent cerebral infarcts associated with cardiac disease and procedures.

    PubMed

    Hassell, Mariëlla E C; Nijveldt, Robin; Roos, Yvo B W; Majoie, Charles B L; Hamon, Martial; Piek, Jan J; Delewi, Ronak

    2013-12-01

    The occurrence of clinically silent cerebral infarcts (SCIs) in individuals affected by cardiac disease and after invasive cardiac procedures is frequently reported. Indeed, atrial fibrillation, left ventricular thrombus formation, cardiomyopathy, and patent foramen ovale have all been associated with SCIs. Furthermore, postprocedural SCIs have been observed after left cardiac catheterization, transcatheter aortic valve implantation, CABG surgery, pulmonary vein isolation, and closure of patent foramen ovale. Such SCIs are often described as precursors to symptomatic stroke and are associated with cognitive decline, dementia, and depression. Increased recognition of SCIs might advance our understanding of their relationship with heart disease and invasive cardiac procedures, facilitate further improvement of therapies or techniques aimed at preventing their occurrence and, therefore, decrease the risk of adverse neurological outcomes. In this Review, we provide an overview of the occurrence and clinical significance of, and the available diagnostic modalities for, SCIs related to cardiac disease and associated invasive cardiac procedures. PMID:24165909

  10. The interference threshold of unipolar cardiac pacemakers in extremely low frequency magnetic fields.

    PubMed

    Scholten, A; Silny, J

    2001-01-01

    The effective induction loop area of implanted cardiac pacemaker (CPM) systems in magnetic fields was determined. The results were verified in a tank model placed in the centre of a Helmholtz-coil-arrangement. Both a left and a right pectorally implanted unipolar dual chamber CPM system were simulated. On this basis and with the results of benchmark-tests the interference thresholds for a collection of modern CPMs in extremely low frequency (ELF) magnetic fields were estimated. The investigations clearly showed that there are two loops, the CPM-lead-tissue-loop and the body loop, responsible for the magnitude of the disturbance voltage on the input of a cardiac pacemaker. The effective induction loop areas rangedfrom 100 to 221 cm2. For a left pectorally implanted, atrially controlled CPM system the interference thresholds for the magnetic induction lay between 16 and 552 micro T (RMS) for frequencies of the magneticfield between 10 and 250 Hz. Thus, there is a limited possibility for an interference of implanted CPM by ELF magnetic fields in everyday life. PMID:11695658

  11. Evaluation of carbon dioxide dissipation within a euthanasia chamber.

    PubMed

    Djoufack-Momo, Shelly M; Amparan, Ashlee A; Grunden, Beverly; Boivin, Gregory P-

    2014-07-01

    CO? euthanasia is used widely for small laboratory animals, such as rodents. A common necessity in many animal research facilities is to euthanize mice in sequential batches. We assessed the effects of several variables on the time it took for CO? to dissipate within a chamber. Using standard euthanasia time, changes in flow rate were compared between a slow 15% fill rate for 7 min, and a slow 15% followed by a rapid 50% filling for a total of 5 min. Additional variables assessed included the effects of opening the lid after the completion of chamber filling, turning the chamber over after completion of filling, and the use and removal of a cage from within the chamber. For all trials, CO? levels in the chambers peaked between 50% and 80%. After the gas was turned off, the concentration of CO? dropped to below 10% COv within 2 min, except when the lid was left on the chamber, where concentration levels remained above 10% after 20 min. CO? dissipation was significantly faster when the chamber was turned upside down after filling. Significant interaction effects occurred among the factors of cage presence within the chamber, flow rate, and chamber position. Only leaving the lid on the chamber had any practical implication for delaying CO? dissipation. We recommend that users allow 2 min for CO? to clear from the chamber before subsequent euthanasia procedures, unless the chamber is manipulated to increase the dissipation rate. PMID:25199098

  12. Evaluation of Carbon Dioxide Dissipation within a Euthanasia Chamber

    PubMed Central

    Djoufack-Momo, Shelly M; Amparan, Ashlee A; Grunden, Beverly; Boivin, Gregory P

    2014-01-01

    CO2 euthanasia is used widely for small laboratory animals, such as rodents. A common necessity in many animal research facilities is to euthanize mice in sequential batches. We assessed the effects of several variables on the time it took for CO2 to dissipate within a chamber. Using standard euthanasia time, changes in flow rate were compared between a slow 15% fill rate for 7 min, and a slow 15% followed by a rapid 50% filling for a total of 5 min. Additional variables assessed included the effects of opening the lid after the completion of chamber filling, turning the chamber over after completion of filling, and the use and removal of a cage from within the chamber. For all trials, CO2 levels in the chambers peaked between 50% and 80%. After the gas was turned off, the concentration of CO2 dropped to below 10% CO2 within 2 min, except when the lid was left on the chamber, where concentration levels remained above 10% after 20 min. CO2 dissipation was significantly faster when the chamber was turned upside down after filling. Significant interaction effects occurred among the factors of cage presence within the chamber, flow rate, and chamber position. Only leaving the lid on the chamber had any practical implication for delaying CO2 dissipation. We recommend that users allow 2 min for CO2 to clear from the chamber before subsequent euthanasia procedures, unless the chamber is manipulated to increase the dissipation rate. PMID:25199098

  13. Toward accurate segmentation of the LV myocardium and chamber for volumes

    E-print Network

    Paris-Sud XI, Université de

    extraction from the images. New algo- rithms for segmenting the heart left ventricle myocardium and chamber to the high level of noise and the signal drops resulting of insufficiently perfused regions. The LV chamber for the estimation of the heart wall thickness and the chamber volume variation during the heart cycle

  14. Hypoxia training attenuates left ventricular remodeling in rabbit with myocardial infarction

    PubMed Central

    Wan, Chun-Xiao; Lan, Yun-Feng; Jiang, Hui; Huang, Jie; Li, Rui-Sheng; Bi, Sheng; Li, Jian-An

    2014-01-01

    Objective Previous studies showed that hypoxia preconditioning could protect cardiac function against subsequent myocardial infarction injury. However, the effect of hypoxia on left ventricular after myocardial infarction is still unclear. This study therefore aims to investigate the effects of hypoxia training on left ventricular remodeling in rabbits post myocardial infarction. Methods Adult male rabbits were randomly divided into three groups: group SO (sham operated), group MI (myocardial infarction only) and group MI-HT (myocardial infarction plus hypoxia training). Myocardial infarction was induced by left ventricular branch ligation. Hypoxia training was performed in a hypobaric chamber (having equivalent condition at an altitude of 4000 m, FiO214.9%) for 1 h/day, 5 days/week for four weeks. At the endpoints, vascular endothelial growth factor (VEGF) in the plasma was measured. Infarct size and capillary density were detected by histology. Left ventricular remodeling and function were assessed by echocardiography. Results After the 4-week experiment, compared with the group SO, plasma VEGF levels in groups MI (130.27 ± 18.58 pg/mL, P < 0.01) and MI-HT (181.93 ± 20.29 pg/mL, P < 0.01) were significantly increased. Infarct size in Group MI-HT (29.67% ± 7.73%) was deceased remarkably, while its capillary density (816.0 ± 122.2/mm2) was significantly increased. For both groups MI and MI-HT, left ventricular end-diastolic and end-systolic dimensions were increased whereas left ventricular ejection fraction was decreased. However, compared with group MI, group MI-HT diminished left ventricular end-diastolic (15.86 ± 1.09 mm, P < 0.05) and end-systolic dimensions (12.10 ± 1.20 mm, P < 0.01) significantly and improved left ventricular ejection fraction (54.39 ± 12.74 mm, P < 0.05). Conclusion Hypoxia training may improve left ventricular function and reduce remodeling via angiogenesis in rabbits with MI. PMID:25278973

  15. Cardiac and arterial interactions in end-stage renal disease

    Microsoft Academic Search

    Gérard M London; Alain P Guerin; Sylvain J Marchais; Bruno Pannier; Michel E Safar; Martin Day; Fabien Metivier

    1996-01-01

    Cardiac and arterial interactions in end-stage renal disease. Although cardiac hypertrophy is a frequent complication of end-stage renal disease (ESRD), relatively little is known about large arterial geometry and function in vivo in these patients, and the relationship between arterial changes and cardiac hypertrophy is unknown. Common carotid artery (CCA) intima-media thickness and internal diameter and left ventricular geometry and

  16. Contour extraction from cardiac MRI studies using snakes

    Microsoft Academic Search

    Surendra Ranganath

    1995-01-01

    The author investigated automatic extraction of left ventricular contours from cardiac magnetic resonance imaging (MRI) studies. The contour extraction algorithms were based on active contour models, or snakes. Based on cardiac MR image characteristics, the author suggested algorithms for extracting contours from these large data sets. The author specifically considered contour propagation methods to make the contours reliable enough despite

  17. The effect of extraanatomic bypass on aortic input impedance studied in open chest dogs. Should the vascular prosthesis be compliant to unload the left ventricle?

    PubMed

    Morita, S; Kuboyama, I; Asou, T; Tokunaga, K; Nose, Y; Nakamura, M; Harasawa, Y; Sunagawa, K

    1991-11-01

    Left ventricular hypertrophy has been reported after ascending aorta-abdominal aorta bypass, despite seemingly insignificant changes in cardiac output and mean arterial pressure. Such a bypass procedure may be used for the treatment of complex coarctation of the aorta, hypoplastic aortic arch, or thoracoabdominal aortic aneurysm. To investigate the effect of the bypass procedure on left ventricular afterload, we measured aortic input impedance in six open chest dogs by placing a knitted Dacron graft from the ascending aorta to the abdominal aorta and occluding the aortic arch. Cardiac output and mean arterial pressure remained unaltered throughout the experiment, consistent with clinical reports. Systolic pressure increased by 25% of control, and the ratio of diastolic pressure-time index to tension-time index decreased by 27%. The measured input impedance was then approximated with the three-element windkessel model, which consists of resistance, compliance, and characteristic impedance (average of impedance modulus between 5 and 15 Hz). There was no change in resistance and compliance; characteristic impedance increased to 255% of control. Connecting an air chamber to the vascular prosthesis doubled the compliance and decreased the characteristic impedance nearly to the control value without altering resistance. It also reduced the systolic pressure by 14% of the bypass protocol and increased the ratio of diastolic pressure-time index to tension-time index (by 32% of control value and 82% of bypass value). Arterial systolic pressure and pulse pressure were both linearly correlated with the characteristic impedance. Thus we conclude that although ascending aorta-abdominal aorta bypass does not affect cardiac output, mean arterial pressure, resistance, or compliance, it does increase characteristic impedance. Left ventricular systolic load is directly correlated with characteristic impedance. Increased systolic wall stress might be the cause of left ventricular hypertrophy of the previously reported cases. Because decrease in the distensibility of the proximal aorta is one of the factors causing the increase in characteristic impedance, using a compliant graft might help to unload the heart. PMID:1834892

  18. Development of the left-right axis in amphibians.

    PubMed

    Yost, H J

    1991-01-01

    The heart and viscera of vertebrates are formed from primordia that are apparently bilaterally symmetrical. This symmetry is broken during development, yielding organs that develop characteristic asymmetries along the left-right axis. Results from three lines of experimentation on embryos of the amphibian Xenopus laevis indicate that left-right asymmetries are established early in development and that cellular interactions transmit left-right information from one primordium to another. First, a cytoplasmic rearrangement that occurs during the first cell cycle after fertilization may establish left-right asymmetry in some regions of the embryo. Second, a variety of experimental results indicate that embryonic ectoderm or its basal extracellular matrix may transmit left-right axial information to cardiac mesoderm and visceral endoderm. Third, inhibition of proteoglycan synthesis during a narrow period of development, concurrent with the migration of the cardiac primordia to the ventral midline, prevents asymmetrical development of the heart. PMID:1802642

  19. Cardiac Efficiency and Oxygen Consumption Measured with 11C-Acetate PET After Long-Term Cardiac Resynchronization Therapy

    Microsoft Academic Search

    Oliver Lindner; Jens Sorensen; J urgen Vogt; Eva Fricke; Detlev Baller; Dieter Horstkotte; Wolfgang Burchert

    Cardiac resynchronization therapy (CRT) is a treatment option in patients with severe heart failure and left bundle-branch block (LBBB). This study evaluated the effects of 4 and 13 mo of CRT on myocardial oxygen consumption (MVO2) and cardiac effi- ciency as compared with mild heart failure patients without LBBB. Methods: Sixteen patients with severe heart failure and LBBBduetoidiopathiccardiomyopathywerestudiedatbaseline andafter 4

  20. Abilities of cardiac MSCT imaging to provide useful anatomical and functional information for Cardiac Resynchronization Therapy optimization

    Microsoft Academic Search

    M. Garreau; M. P. Garcia; F. Tavard; A. Simon; J. Fleureau; J. Velut; D. Boulmier; P. Haigron; C. Toumoulin; C. Leclercq

    2010-01-01

    A main limit of biventricular Cardiac Resynchronization Therapy (CRT) is the high rate of non-responder. A challenging task to carry out remains both the identification of the most effective pacing sites and the left ventricular lead positioning by a venous access. This paper aims to show how cardiac CT imaging can be helpful for the clinician to analyse venous system

  1. HMGB1-stimulated human primary cardiac fibroblasts exert a paracrine action on human and murine cardiac stem cells

    Microsoft Academic Search

    Alessandra Rossini; Antonella Zacheo; David Mocini; Pierangela Totta; Antonio Facchiano; Raffaella Castoldi; Paolo Sordini; Giulio Pompilio; Damiano Abeni; Maurizio C. Capogrossi; Antonia Germani

    2008-01-01

    High Mobility Box 1 Protein (HMGB1) is a cytokine released into the extracellular space by necrotic cells and activated macrophages in response to injury. We recently demonstrated that HMGB1 administration into the mouse heart during acute myocardial infarction induces cardiac tissue regeneration by activating resident cardiac c-kit+ cells (CSCs) and significantly enhances left ventricular function. In the present study it

  2. Prediction of Mortality Risk by Different Methods of Indexation for Left Ventricular Mass

    Microsoft Academic Search

    Youlian Liao; Richard S. Cooper; Ramon Durazo-Arvizu; George A. Mensah; Jalal K. Ghali

    1997-01-01

    Objectives. We sought to compare the predictive value of echocardiographically determined left ventricular hypertrophy on death from all causes and cardiac mortality using various methods of indexation for left ventricular mass.Background. Considerable controversy exists regarding the optimal method for indexing left ventricular mass to body size in the clinical setting.Methods. The study included 988 consecutive patients who had both coronary

  3. Cardiac nociceptive reflexes after transmyocardial laser revascularization: Implications for the neural hypothesis of angina relief

    Microsoft Academic Search

    Anthony J. Minisi; On Topaz; M. Susan Quinn; Laxmi B. Mohanty

    2001-01-01

    Objective: The mechanism by which transmyocardial laser revascularization relieves angina is not understood. One theory is that laser-induced thermal damage to cardiac nerves results in cardiac denervation. This study examined the acute effects of transmyocardial laser revascularization on reflex responses mediated by cardiac nociceptors, the left ventricular receptors with sympathetic afferent fibers that are thought to mediate anginal chest pain.

  4. Assessment of global cardiac function in MSCT imaging using fuzzy connectedness segmentation

    Microsoft Academic Search

    J. Fleureau; M. Garreau; A. Simon; R. Hachemani; D. Boulmier

    2008-01-01

    The goal of this work is to assess global cardiac function in terms of ventricular volume from multi-slice computed tomography dynamic dataset. We propose an approach for the segmentation of the left ventricle and the measurement of the ventricular volume along the whole cardiac cycle. It is based on the segmentation of the left cavities using a fuzzy connectedness algorithm.

  5. Vertical two chamber reaction furnace

    Microsoft Academic Search

    Blaugher; Richard D

    1999-01-01

    A vertical two chamber reaction furnace. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber.

  6. Cardiac Circulation

    NSDL National Science Digital Library

    PhD Jack D Thatcher (West Virginia School of Osteopathic Medicine Structural Biology)

    2009-11-20

    This simple FlashTM animation depicts blood flow through the great vessels and chambers of the mature heart. Clicking brings up labels. A second click brings up arrows defining venous flow. A third click brings up arrows tracing the arterial flow.

  7. Acute Heart Failure and a Pseudo Cystic Image in the Left Ventricle

    PubMed Central

    RIMBAS, Roxana C.; VINEREANU, Dragos

    2014-01-01

    The association between acute heart failure (AHF) and cardiac tumor may change the short and long term management of both conditions. A 51-year-old man presented with signs of AHF. ECG showed sinus tachycardia and left ventricular (LV) hypertrophy. Chest x-Ray found dilated heart and pulmonary congestion. There were no significant changes in blood tests. Transthoracic echocardiography revealed chambers dilation, and LV ejection fraction (LVEF) of 17%. Unexpectedly, we found an apical 2/2 cm cystic image in the LV. This had a myocardium-like membrane, seen better in 3D echocardiography, suggestive for hydatic cyst. Cerebral, thoracic, and abdomino-pelvic CT scan showed no hydatic lesions. Anti-Echinococcus antibodies were negative. Initially the clinical challenge was the management of the tumor in a patient with AHF and dilated cardiomyopathy. He was treated for AHF and followed up for the cystic image. He exhibited significant improvement of the clinical status and LVEF (increased to 42 %), with important cardiac reverse remodeling. Surprisingly, the apical cystic image disappeared. However, we found a hypertrophic aberrant cordae from apex to mid-septum, in the same position as the previous image. Thus, we believe that this cordae, by important remodeling and torsion generated the cystic image. This case highlights the importance of serial 2D and 3D echo examinations in patients with severely remodeled LV, and also with tumoral images. PMID:25705277

  8. [Left ventricular assist system].

    PubMed

    Kyo, Shunei; Nishimura, Motonobu; Asano, Haruhiko

    2002-09-01

    Two types of artificial heart, the total artificial heart (TAH) and ventricular assist system (VAS), have been utilized in patients with end-stage heart failure waiting for heart transplantation (bridge to transplantation). The TAH is a system to replace the native heart, whereas the VAS is a system to support the left ventricle (LVAS), right ventricle (RVAS), or both ventricles (BVAS) while maintaining native cardiac function. There are two types of VAS, paracorporeal VAS and implantable VAS. Implantable VAS devices such as Novacor LVAS and HeartMate LVAS are only available for LVAS, although paracorporeal VAS, such as Toyobo VAS, Zeon VAS, and Thoratec VAS, are available for RVAS, LVAS, or BVAS. Due to recent advances in the VAS, the "patient discharge program" from hospital has been promoted for improvement of the quality of life (QOL) and reduction of medical costs. VAS also have been utilized as "bridges to recovery" for native hearts or for "semipermanent use" in patients without indications for heart transplantation, and superior clinical results of VAS therapy compared with conservative therapy have been reported in terms of one-year survival rate and improvement of QOL. Recently, several inexpensive VAS systems with an axial or centrifugal pump have been developed and the initial clinical trials of these systems have recently started in Western countries. Another remarkable technological advance in VAS is the Lion Heart (Arrow) which is a totally implantable VAS system the includes an energy transmission system. We expect that recent technological progress in VAS will improve the survival and QOL in patients with end-stage heart failure. PMID:12386952

  9. Cardiac optogenetics.

    PubMed

    Entcheva, Emilia

    2013-05-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart. PMID:23457014

  10. Cardiac optogenetics

    PubMed Central

    2013-01-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart. PMID:23457014

  11. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  12. Increase in cardiac myosin heavy-chain (MyHC) alpha protein isoform in hibernating ground squirrels, with echocardiographic visualization of ventricular wall hypertrophy and prolonged contraction.

    PubMed

    Nelson, O Lynne; Rourke, Bryan C

    2013-12-15

    Deep hibernators such as golden-mantled ground squirrels (Callospermophilus lateralis) have multiple challenges to cardiac function during low temperature torpor and subsequent arousals. As heart rates fall from over 300 beats min(-1) to less than 10, chamber dilation and reduced cardiac output could lead to congestive myopathy. We performed echocardiography on a cohort of individuals prior to and after several months of hibernation. The left ventricular chamber exhibited eccentric and concentric hypertrophy during hibernation and thus calculated ventricular mass was ~30% greater. Ventricular ejection fraction was mildly reduced during hibernation but stroke volumes were greater due to the eccentric hypertrophy and dramatically increased diastolic filling volumes. Globally, the systolic phase in hibernation was ~9.5 times longer, and the diastolic phase was 28× longer. Left atrial ejection generally was not observed during hibernation. Atrial ejection returned weakly during early arousal. Strain echocardiography assessed the velocity and total movement distance of contraction and relaxation for regional ventricular segments in active and early arousal states. Myocardial systolic strain during early arousal was significantly greater than the active state, indicating greater total contractile movement. This mirrored the increased ventricular ejection fraction noted with early arousal. However, strain rates were slower during early arousal than during the active period, particularly systolic strain, which was 33% of active, compared with the rate of diastolic strain, which was 67% of active. As heart rate rose during the arousal period, myocardial velocities and strain rates also increased; this was matched closely by cardiac output. Curiously, though heart rates were only 26% of active heart rates during early arousal, the cardiac output was nearly 40% of the active state, suggesting an efficient pumping system. We further analyzed proportions of cardiac myosin heavy-chain (MyHC) isoforms in a separate cohort of squirrels over 5 months, including time points before hibernation, during hibernation and just prior to emergence. Hibernating individuals were maintained in both a 4°C cold room and a 20°C warm room. Measured by SDS-PAGE, relative percentages of cardiac MyHC alpha were increased during hibernation, at both hibernacula temperatures. A potential increase in contractile speed, and power, from more abundant MyHC alpha may aid force generation at low temperature and at low heart rates. Unlike many models of cardiomyopathies where the alpha isoform is replaced by the beta isoform in order to reduce oxygen consumption, ground squirrels demonstrate a potential cardioprotective mechanism to maintain cardiac output during torpor. PMID:24072796

  13. Increase in cardiac myosin heavy-chain (MyHC) alpha protein isoform in hibernating ground squirrels, with echocardiographic visualization of ventricular wall hypertrophy and prolonged contraction

    PubMed Central

    Nelson, O. Lynne; Rourke, Bryan C.

    2013-01-01

    SUMMARY Deep hibernators such as golden-mantled ground squirrels (Callospermophilus lateralis) have multiple challenges to cardiac function during low temperature torpor and subsequent arousals. As heart rates fall from over 300 beats min?1 to less than 10, chamber dilation and reduced cardiac output could lead to congestive myopathy. We performed echocardiography on a cohort of individuals prior to and after several months of hibernation. The left ventricular chamber exhibited eccentric and concentric hypertrophy during hibernation and thus calculated ventricular mass was ~30% greater. Ventricular ejection fraction was mildly reduced during hibernation but stroke volumes were greater due to the eccentric hypertrophy and dramatically increased diastolic filling volumes. Globally, the systolic phase in hibernation was ~9.5 times longer, and the diastolic phase was 28× longer. Left atrial ejection generally was not observed during hibernation. Atrial ejection returned weakly during early arousal. Strain echocardiography assessed the velocity and total movement distance of contraction and relaxation for regional ventricular segments in active and early arousal states. Myocardial systolic strain during early arousal was significantly greater than the active state, indicating greater total contractile movement. This mirrored the increased ventricular ejection fraction noted with early arousal. However, strain rates were slower during early arousal than during the active period, particularly systolic strain, which was 33% of active, compared with the rate of diastolic strain, which was 67% of active. As heart rate rose during the arousal period, myocardial velocities and strain rates also increased; this was matched closely by cardiac output. Curiously, though heart rates were only 26% of active heart rates during early arousal, the cardiac output was nearly 40% of the active state, suggesting an efficient pumping system. We further analyzed proportions of cardiac myosin heavy-chain (MyHC) isoforms in a separate cohort of squirrels over 5 months, including time points before hibernation, during hibernation and just prior to emergence. Hibernating individuals were maintained in both a 4°C cold room and a 20°C warm room. Measured by SDS-PAGE, relative percentages of cardiac MyHC alpha were increased during hibernation, at both hibernacula temperatures. A potential increase in contractile speed, and power, from more abundant MyHC alpha may aid force generation at low temperature and at low heart rates. Unlike many models of cardiomyopathies where the alpha isoform is replaced by the beta isoform in order to reduce oxygen consumption, ground squirrels demonstrate a potential cardioprotective mechanism to maintain cardiac output during torpor. PMID:24072796

  14. Calcified amorphous tumor in left atrium presenting with cerebral infarction

    PubMed Central

    Suh, Jong Hui; Kwon, Jong Bum; Park, Kuhn

    2014-01-01

    Calcified amorphous tumor (CAT) of the heart is an extremely rare cardiac mass. We describe a case of cardiac CAT in a 70-year-old Korean female who presented with acute onset dysarthria and right side weakness. Echocardiography and chest computed tomography revealed a left atrial mass that originated from the interatrial septum. The patient underwent surgical resection and pathologic examination demonstrated CAT. Postoperative course was uneventful and she was followed without recurrence. PMID:25276375

  15. Right ventricular enlargement mimicking electrocardiographic left ventricular pacing.

    PubMed

    Hemminger, Eric James; Criley, John Michael

    2006-04-01

    Electrocardiographic right bundle branch block morphology during cardiac pacing is occasionally the result of accidental placement of pacemaker or defibrillator leads into the left ventricle. Inadvertent lead placement in the left heart is associated with a risk of systemic embolism. Previous authors have attempted to define safe (right ventricular origin) and unsafe (left ventricular origin) patterns of right bundle branch block during pacing. We report a case of a patient with severe dilated cardiomyopathy and a correctly positioned pacemaker-defibrillator lead in the right ventricular apex, who meets electrocardiographic criteria for lead implantation into the left ventricle. PMID:16580416

  16. Sudden Cardiac Arrest

    MedlinePLUS

    ... the NHLBI on Twitter. What Is Sudden Cardiac Arrest? Sudden cardiac arrest (SCA) is a condition in which the heart ... This Content: Next >> April 1, 2011 Sudden Cardiac Arrest Clinical Trials Clinical trials are research studies that ...

  17. Cardiac pacemakers: an update.

    PubMed

    Johnson, Charles D; Arzola-Castañer, Daniel

    2003-01-01

    In this update of cardiac pacing we review the new revised ACC/AHA/NASPE Guidelines for implantation of cardiac pacemakers, including selection of pacing mode, possible new indications, and other more recent advances in cardiac pacing. PMID:15008358

  18. Cardiac Syndrome X

    MedlinePLUS

    ... What causes cardiac syndrome X? There are many theories about what causes cardiac syndrome X. Some doctors ... disease. How is cardiac syndrome X treated? A number of medicines can help relieve the angina pain ...

  19. High resolution MR imaging of the fetal heart with cardiac triggering: a feasibility study in the sheep fetus.

    PubMed

    Yamamura, Jin; Schnackenburg, Bernhard; Kooijmann, Hendrik; Frisch, Michael; Hecher, Kurt; Adam, Gerhard; Wedegärtner, Ulrike

    2009-10-01

    The aim of this study was to perform fetal cardiac magnetic resonance imaging (MRI) with triggering of the fetal heart beat in utero in a sheep model. All experimental protocols were reviewed and the usage of ewes and fetuses was approved by the local animal protection authorities. Images of the hearts of six pregnant ewes were obtained by using a 1.5-T MR system (Philips Medical Systems, Best, Netherlands). The fetuses were chronically instrumented with a carotid catheter to measure the fetal heart frequency for the cardiac triggering. Pulse wave triggered, breath-hold cine-MRI with steady-state free precession (SSFP) was achieved in short axis, two-, four- and three-chamber views. The left ventricular volume and thus the function were measured from the short axis. The fetal heart frequencies ranged between 130 and 160 bpm. The mitral, tricuspid, aortic, and pulmonary valves could be clearly observed. The foramen ovale could be visualized. Myocardial contraction was shown in cine sequences. The average blood volume at the end systole was 3.4 + or - 0.2 ml (+ or - SD). The average volume at end diastole was 5.2 + or - 0.2 ml; thus the stroke volumes of the left ventricle in the systole were between 1.7 and 1.9 ml with ejection fractions of 38.6% and 39%, respectively. The pulse wave triggered cardiac MRI of the fetal heart allowed evaluation of anatomical structures and functional information. This feasibility study demonstrates the applicability of MRI for future evaluation of fetuses with complex congenital heart defects, once a noninvasive method has been developed to perform fetal cardiac triggering. PMID:19430796

  20. [Cardiac echinococcosis. Report of a case].

    PubMed

    Busacca, G; Puzzo, A; Fiamma, G

    1998-01-01

    Cardiac hydatid disease represents 0.02-2% of the possible locations of the parasite. The case of an asymptomatic 60-year-old male patient, hospitalised for mnesic and cognitive disease, and with history of hepatic and pulmonary echinococcosis is reported. The patient showed a cardiac cyst localised in the mediobasal portion of the ventricular septum, with partial obstruction of the left ventricular outflow tract and with alteration of the left ventricular compliance. This case is of particular interest either for the rarity of cardiac localization or disagreement between the severity of anatomic involvement and absence of correlated symptoms. Therefore all patients affected by hydatid disease could be routinely investigated by 2D echo because this imaging technique is non invasive, feasible and has a high sensitivity for detecting intracardiac echinococcal cysts. PMID:9780620

  1. Autologous heart cell transplantation improves cardiac function after myocardial injury

    Microsoft Academic Search

    Tetsuro Sakai; Ren-Ke Li; Richard D Weisel; Donald A. G Mickle; Eung-Joong Kim; Shinji Tomita; Zhi-Qian Jia; Terrence M Yau

    1999-01-01

    Background. Fetal ventricular cardiomyocyte transplantation into a cardiac scar improved ventricular function, but these cells were eventually eliminated by rejection. We therefore examined the feasibility of autologous adult heart cell transplantation.Methods. A transmural scar was produced in the left ventricular free wall of adult rats by cryoinjury. The left atrial appendage was harvested, and the atrial heart cells were cultured

  2. The Mobile Chamber

    NASA Technical Reports Server (NTRS)

    Scharfstein, Gregory; Cox, Russell

    2012-01-01

    A document discusses a simulation chamber that represents a shift from the thermal-vacuum chamber stereotype. This innovation, currently in development, combines the capabilities of space simulation chambers, the user-friendliness of modern-day electronics, and the modularity of plug-and-play computing. The Mobile Chamber is a customized test chamber that can be deployed with great ease, and is capable of bringing payloads at temperatures down to 20 K, in high vacuum, and with the desired metrology instruments integrated to the systems control. Flexure plans to lease Mobile Chambers, making them affordable for smaller budgets and available to a larger customer base. A key feature of this design will be an Apple iPad-like user interface that allows someone with minimal training to control the environment inside the chamber, and to simulate the required extreme environments. The feedback of thermal, pressure, and other measurements is delivered in a 3D CAD model of the chamber's payload and support hardware. This GUI will provide the user with a better understanding of the payload than any existing thermal-vacuum system.

  3. Static diffusion cloud chambers

    NASA Technical Reports Server (NTRS)

    Ayers, G.

    1981-01-01

    The chamber geometry and optical arrangement are described. The supersaturation range is given and consists of readings taken at five fixed points: 0.25%, 0.5%, 0.75%, 1.0%, and 1.25%. The detection system is described including light source, cameras, and photocell detectors. The temperature control and the calibration of the chamber are discussed.

  4. Cardiac Arrhythmia Detection By ECG Feature Extraction

    NASA Astrophysics Data System (ADS)

    Mane, Rameshwari S.; Cheeran, A. N.; Awandekar, Vaibhav D.; Rani, Priya

    2013-03-01

    Electrocardiogram (ECG) is a noninvasive technique used as a primary diagnostic tool for detecting cardiovascular diseases. One of the important cardiovascular diseases is cardiac arrhythmia. Computer-assisted cardiac arrhythmia detection and classification can play a significant role in the management of cardiac disorders. This paper presents an algorithm developed using Python 2.6 simulation tool for the detection of cardiac arrhythmias e.g. premature ventricular contracture (PVC), right bundle branch block (R or RBBB) and left bundle branch block (L or LBBB) by extracting various features and vital intervals (i.e. RR, QRS, etc) from the ECG waveform. The proposed method was tested over the MIT-BIH Arrhythmias Database.

  5. Cardiac Rehabilitation in Older Cardiac Patients

    Microsoft Academic Search

    Philip A. Ades

    Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise,\\u000a cardiac risk factor modification, education and counseling. These programs are designed to limit the physiologic and psychologic\\u000a effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse\\u000a the atherosclerotic process, and enhance the psychosocial and vocational status of patients with

  6. The cost-utility of left ventricular assist devices for end-stage heart failure patients ineligible for cardiac transplantation: a systematic review and critical appraisal of economic evaluations

    PubMed Central

    Van den Bruel, Ann; Smit, Yolba; De Jonge, Nicolaas; Vlayen, Joan

    2014-01-01

    Background A health technology assessment (HTA) of left ventricular assist devices (LVADs) as destination therapy in patients with end-stage heart failure was commissioned by the Dutch Health Care Insurance Board [College voor Zorgverzekeringen (CVZ)]. In this context, a systematic review of the economic literature was performed to assess the procedure’s value for money. Methods A systematic search (updated in December 2013) for economic evaluations was performed by consulting various databases: the HTA database produced by the Centre for Reviews and Dissemination (CRD HTA), websites of HTA institutes, CRD’s National Health Service Economic Evaluation Database (NHS EED), Medline (OVID) and EMBASE. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two people. References of the selected studies were checked for additional relevant citations. Results Six relevant studies were selected. Four economic evaluations relied on the results of the REMATCH trial to compare a pulsatile-flow LVAD with optimal medical therapy (OMT). These evaluations were performed before the publication of the HeartMate II (HM-II) Destination Therapy Trial which compared a pulsatile-flow with a continuous-flow LVAD. Two more recent economic evaluations combined the results of both trials to make an indirect comparison of a continuous-flow LVAD with OMT. In all studies, the largest part of the incremental cost was due to the reimplantation cost of an LVAD, with a device cost of €58,000-€75,000 and about €55,000 for the surgical procedure. The survival gain was highest with a continuous-flow LVAD, up to about three life-years gained (LYG) versus OMT in the most optimistic study. Quality of life (QoL) was improved but measures with a generic utility instrument were lacking, making estimates on quality-adjusted life-years (QALYs) gained more uncertain. Incremental cost-effectiveness ratios of the two most recent studies were on average €107,600 and $198,184 (ca.€145,800) per QALY gained. Conclusions Although LVAD destination therapy improves survival and QoL, it remains questionable as to whether it offers value for money. This conclusion may alter if the price of the device/procedure decreases sufficiently, in combination with further improved outcomes for mortality, adverse events and QoL. PMID:25452904

  7. Vertical two chamber reaction furnace

    Microsoft Academic Search

    Blaugher

    1999-01-01

    A vertical two chamber reaction furnace is disclosed. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the

  8. Multiple piston expansion chamber engine

    Microsoft Academic Search

    1988-01-01

    The method of operation for the extraction of work from combusted products in two chambers hereafter referred to as working and auxiliary having a means of controlling isolation between the two the chambers is described comprising of isolating the working chamber from the auxiliary chamber when the working chamber piston is at substantially TDC, admitting a charge of pressurized carbureted

  9. Left ventricular mechanics in Behcet’s disease: A speckle tracking echocardiographic study

    PubMed Central

    Demirelli, Selami; Degirmenci, Hüsnü; Bilen, Handan; Ermis, Emrah; Duman, Hakan; Arisoy, Arif; Bakirci, Eftal Murat; Ipek, Emrah; Askin, Lutfu

    2014-01-01

    Although cardiac involvement is rarely seen in Behcet’s disease (BD), it is essential to detect subclinical left ventricular (LV) dysfunction for prognostic purposes. Herein we aimed to show the role of two dimensional (2D) speckle tracking echocardiography (STE) in determination of subclinical LV dysfunction in patients with BD. 30 patients diagnosed as BD due to International Study Group Behcet’s diagnostic criteria and 25 control subjects underwent Doppler echocardiography including pulsed tissue Doppler of the mitral annulus and speckle-tracking echocardiography. LV peak longitudinal strain and strain rate (SR) was calculated in four-chamber (4C), apical long-axis (LAX), and two-chamber (2C) views, and values of the three views were averaged LV global longitudinal strain (LV-GLS) and SR. LV torsion was determined as the net difference in the mean rotation between the apical and basal levels. There was not any significant difference in age and gender between groups. Patients with BD had significantly lower LV longitudinal strain and Sr measurements than the control group. Although LV basal rotation (LVR) basal values were similar in both groups, LVR-apical and LV torsion (LVTR) values were significantly higher in patient group. LVR-apical and LV-GLS were found to have a good positive corelation (r: 0.44, p<0.001) (r: -0.56, r: -0.65, respectively. p<0.001). There was a weak positive correlation between LVTR and LV-GLS (r: 0.29, p<0.05). We demonstrated that combined assessment of LV-GLS, LV-GLSR, LVTR and LVR-apical values detected by STE can be useful in determination of subclinical left ventricular dysfunction in BD. PMID:25172976

  10. Effect of rate-dependent left bundle branch block on global and regional left ventricular function

    SciTech Connect

    Bramlet, D.A.; Morris, K.G.; Coleman, R.E.; Albert, D.; Cobb, F.R.

    1983-05-01

    Seven subjects with rate-dependent left bundle branch block (RDLBBB) and 13 subjects with normal conduction (control group) underwent upright bicycle exercise radionuclide angiography to determine the effects of the development of RDLBBB on global and regional left ventricular function. Six of the seven subjects with RDLBBB had atypical chest pain syndromes; none had evidence of cardiac disease based on clinical examination and either normal cardiac catheterization or exercise thallium-201 scintigraphy. Radionuclide angiograms were recorded at rest and immediately before and after RDLBBB in the test group, and at rest and during intermediate and maximal exercise in the control group. The development of RDLBBB was associated with an abrupt decrease in left ventricular ejection fraction (LVEF) in six of seven patients (mean decrease 6 +/- 5%) and no overall increase in LVEF between rest and maximal exercise (65 +/- 9% and 65 +/- 12%, respectively). In contrast, LVEF in the control group was 62 +/- 8% at rest and increased to 72 +/- 8% at intermediate and 78 +/- 7% at maximal exercise. The onset of RDLBBB was associated with the development of asynchronous left ventricular contraction in each patient and hypokinesis in four of seven patients. All patients in the control group had normal wall motion at rest and exercise. These data indicate that the development of RDLBBB is associated with changes in global and regional ventricular function that may be confused with development of left ventricular ischemia during exercise.

  11. [Changes in the physical properties of the arterial system and left ventricular performance with age and in permanent arterial hypertension: their interrelation].

    PubMed

    Mérillon, J P; Motté, G; Masquet, C; Azancot, I; Aumont, M C; Guiomard, A; Gourgon, R

    1982-06-01

    The purpose of this work was to study interactions between physical properties of the arterial system and left ventricular performance during aging in normal and in hypertensive patients. 50 patients were studied; 28 normal patients (age range 22 to 68 years) and 22 patients with essential hypertension (age range 23 to 63 years). In hypertensive patients, the end systolic pressure-volume ratio (ESP/ESV), modulus of chamber stiffness (kp), left ventricular wall thickness (h), mass (m), m/LVEDV ratio (LVEDV: left ventricular end diastolic volume), systemic arterial resistance (SAR), pulse wave velocity (C) and characteristic impedance of the ascending aorta (Zc) were increased compared to normal subjects of similar age. The ejection fraction (EF), the mean velocity of fiber shortening (VCF) and dp/dt max were unchanged. In normal patients: the ESP/ESV ratio, kp, h, m, m/LVEDV ratio, SAR, C and Zc increased with age; there were no age related changes in EF, VCF or dp/dt max. In both groups, there was a close relationship between the m/LVEDV ratio and Zc, the characteristic impedance of the ascending aorta. These results suggest that: 1. aging and arterial hypertension lead to similar changes in the physical properties of the arterial system and in left ventricular performance; 2. in both cases, the development of concentric cardiac hypertrophy is closely related to the physical properties of the arterial system. PMID:6810815

  12. Hydatid disease involving the left ventricle: a case of unusual combination.

    PubMed

    Nurkalem, Zekeriya; Atmaca, Husnu; Kayacioglu, Ilyas; Uslu, Nevzat; Gorgulu, Sevket; Eren, Mehmet

    2006-09-20

    Hydatid cyst can be found in many organ systems, but is rarely in the heart. Echocardiography is an important tool in diagnosing cardiac involvement of a hydatid cyst. A history of extracardiac hydatid cyst should raise suspicion whether there is cardiac involvement. We report a case of spinal hydatid cyst with left ventricular hydatid cyst, yet without any hepatic or pulmonary involvement. PMID:16859775

  13. Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma

    PubMed Central

    2010-01-01

    Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization. PMID:20047692

  14. Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma

    Microsoft Academic Search

    Anderanik Tomasian; Chi Lai; Stefan Ruehm; Mayil S Krishnam

    2010-01-01

    Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization.

  15. Experimental Assessment of Angle-Independent Myocardial Elastography Performance Using a Left-

    E-print Network

    Konofagou, Elisa E.

    - mimicking phantom of the human left ventricle (LV) that underwent physiologic, cardiac motion configurations-temporal resolution have contributed to making cardiac ultrasound the standard of care in the clinic. However, despite. Existing quantitative modalities such as Tissue Doppler Imaging (TDI) [1], Strain Rate Imaging (SRI) [2

  16. Left ventricular abnormalities in children, adolescents and young adults with renal disease

    Microsoft Academic Search

    Lilian M Johnstone; Colin L Jones; Leeanne E Grigg; James L Wilkinson; Rowan G Walker; Harley R Powell

    1996-01-01

    Left ventricular abnormalities in children, adolescents and young adults with renal disease. The cardiac abnormalities that complicate chronic renal failure and renal replacement therapy are not well characterized in young people. These abnormalities are becoming more important because successful renal transplantation has resulted in children with end-stage renal failure living longer. Echocardiographic abnormalities of cardiac function and structure were studied

  17. Assessment of coronary artery and cardiac function using multidetector CT.

    PubMed

    Mochizuki, Teruhito; Hosoi, Satoshi; Higashino, Hiroshi; Koyama, Yasushi; Mima, Tsutomu; Murase, Kenya

    2004-04-01

    Multidetector CT is able to reconstruct artifact-less cardiac images due to improved temporal resolution. In this article, we review the potential benefits of the cardiac application of multidetector CT in the assessment of coronary artery and cardiac function, such as wall motion and systolic thickening. By applying retrospective ECG-gating, 10 phases throughout 1 cardiac cycle are extracted for functional analysis. Animated movies are generated by paging through these 2D and 3D images in cardiac phase order. Left ventricular end-diastolic volume, end-systolic volume, and ejection fraction can also be generated. Using the data acquired during a single breath hold, coronary artery and cardiac function can be assessed by multidetector CT. PMID:15160792

  18. Acoustic-Levitation Chamber

    NASA Technical Reports Server (NTRS)

    Barmatz, M. B.; Granett, D.; Lee, M. C.

    1984-01-01

    Uncontaminated environments for highly-pure material processing provided within completely sealed levitation chamber that suspends particles by acoustic excitation. Technique ideally suited for material processing in low gravity environment of space.

  19. Echocardiographic abnormalities following cardiac radiation

    SciTech Connect

    Perrault, D.J.; Levy, M.; Herman, J.D.; Burns, R.J.; Bar Shlomo, B.Z.; Druck, M.N.; Wu, W.Q.; McLaughlin, P.R.; Gilbert, B.W.

    1985-04-01

    Five years or more after receiving cardiac radiation, 41 patients with Hodgkin's disease and seminoma in remission were subjected to echocardiography. The abnormalities detected included pericardial thickening in 70%, thickening of the aortic and/or mitral valves in 28%, right ventricular dilatation or hypokinesis in 39%, and left ventricular dysfunction in 39%. In the 23 patients treated by an upper mantle technique with shielding, the incidence of right ventricular abnormalities and valvular thickening was significantly lower than in patients treated with modified techniques. Although no symptoms were attributable to the observed abnormalities, longer follow-up time may reveal important functional implications.

  20. Echocardiographic assessment of cardiac disease

    NASA Technical Reports Server (NTRS)

    Popp, R. L.

    1976-01-01

    The physical principles and current applications of echocardiography in assessment of heart diseases are reviewed. Technical considerations and unresolved points relative to the use of echocardiography in various disease states are stressed. The discussion covers normal mitral valve motion, mitral stenosis, aortic regurgitation, atrial masses, mitral valve prolapse, and idiopathic hypertrophic subaortic stenosis. Other topics concern tricuspic valve abnormalities, aortic valve disease, pulmonic valve, pericardial effusion, intraventricular septal motion, and left ventricular function. The application of echocardiography to congenital heart disease diagnosis is discussed along with promising ultrasonic imaging systems. The utility of echocardiography in quantitative evaluation of cardiac disease is demonstrated.

  1. Mercury Chamber Considerations

    E-print Network

    McDonald, Kirk

    Mercury Chamber Considerations V. Graves IDS-NF Target Studies July 2011 #12;2 Managed by UT-Battelle for the U.S. Department of Energy Mercury Chamber Considerations, July 2011 Flow Loop Review · 1 cm dia nozzle, 20 m/s jet requires 1.57 liter/sec mercury flow (94.2 liter/min, 24.9 gpm). · MERIT experiment

  2. Slurry-Mixing Chamber

    NASA Technical Reports Server (NTRS)

    Lewis, E. V.

    1985-01-01

    Paddles and water jets create uniform, continuous flow. Slurry-mixing chamber on hydrojet-jaw mining machine ensures uniform, continuously flowing slurry of coal particles in water. By mixing coal and water at high speed and keeping resulting slurry in constant motion, chamber prevents slurry from becoming dry semisolid that blocks flow. Also prevents coal particles from settling and caking in bends, corners, and other locations where flow changes in direction or speed.

  3. Cardiac output changes during hyperbaric hyperoxia

    Microsoft Academic Search

    Birger Neubauer; Kay Tetzlaff; Carl-Michael Staschen; Eyke Bettinghausen

    2001-01-01

    Objectives: Increased ambient pressure and oxygen partial pressure (pO2) influence cardiovascular regulation during diving and caisson work. We measured the cardiac output (Q?) in subjects who practiced moderate work at a usual diving depth of 30?m. Methods: In 23 healthy male Navy divers who performed steady state bicycle exercises (100?W workload) in a hyperbaric chamber Q? was measured by a

  4. Using the Nova target chamber for high-yield targets

    SciTech Connect

    Pitts, J.H.

    1987-09-28

    The existing 2.2-m-radius Nova aluminum target chamber, coated and lined with boron-seeded carbon shields, is proposed for use with 1000-MJ-yield targets in the next laser facility. The laser beam and diagnostic holes in the target chamber are left open and the desired 10/sup -2/ Torr vacuum is maintained both inside and outside the target chamber; a larger target chamber room is the vacuum barrier to the atmosphere. The hole area available is three times that necessary to maintain a maximum fluence below 12 J/cm/sup 2/ on optics placed at a radius of 10 m. Maximum stress in the target chamber wall is 73 MPa, which complies with the intent of the ASME Pressure Vessel Code. However, shock waves passing through the inner carbon shield could cause it to comminute. We propose tests and analyses to ensure that the inner carbon shield survives the environment. 13 refs.

  5. Sleeve reaction chamber system

    DOEpatents

    Northrup, M. Allen (Berkeley, CA); Beeman, Barton V. (San Mateo, CA); Benett, William J. (Livermore, CA); Hadley, Dean R. (Manteca, CA); Landre, Phoebe (Livermore, CA); Lehew, Stacy L. (Livermore, CA); Krulevitch, Peter A. (Pleasanton, CA)

    2009-08-25

    A chemical reaction chamber system that combines devices such as doped polysilicon for heating, bulk silicon for convective cooling, and thermoelectric (TE) coolers to augment the heating and cooling rates of the reaction chamber or chambers. In addition the system includes non-silicon-based reaction chambers such as any high thermal conductivity material used in combination with a thermoelectric cooling mechanism (i.e., Peltier device). The heat contained in the thermally conductive part of the system can be used/reused to heat the device, thereby conserving energy and expediting the heating/cooling rates. The system combines a micromachined silicon reaction chamber, for example, with an additional module/device for augmented heating/cooling using the Peltier effect. This additional module is particularly useful in extreme environments (very hot or extremely cold) where augmented heating/cooling would be useful to speed up the thermal cycling rates. The chemical reaction chamber system has various applications for synthesis or processing of organic, inorganic, or biochemical reactions, including the polymerase chain reaction (PCR) and/or other DNA reactions, such as the ligase chain reaction.

  6. Computational modeling and analysis for left ventricle motion using CT/Echo image fusion

    NASA Astrophysics Data System (ADS)

    Kim, Ji-Yeon; Kang, Nahyup; Lee, Hyoung-Euk; Kim, James D. K.

    2014-03-01

    In order to diagnose heart disease such as myocardial infarction, 2D strain through the speckle tracking echocardiography (STE) or the tagged MRI is often used. However out-of-plane strain measurement using STE or tagged MRI is inaccurate. Therefore, strain for whole organ which are analyzed by simulation of 3D cardiac model can be applied in clinical diagnosis. To simulate cardiac contraction in a cycle, cardiac physical properties should be reflected in cardiac model. The myocardial wall in left ventricle is represented as a transversely orthotropic hyperelastic material, with the fiber orientation varying sequentially from the epicardial surface, through about 0° at the midwall, to the endocardial surface. A time-varying elastance model is simulated to contract myocardial fiber, and physiological intraventricular systolic pressure curves are employed for the cardiac dynamics simulation in a cycle. And an exact description of the cardiac motion should be acquired in order that essential boundary conditions for cardiac simulation are obtained effectively. Real time cardiac motion can be acquired by using echocardiography and exact cardiac geometrical 3D model can be reconstructed using 3D CT data. In this research, image fusion technology from CT and echocardiography is employed in order to consider patient-specific left ventricle movement. Finally, longitudinal strain from speckle tracking echocardiography which is known to fit actual left ventricle deformation relatively well is used to verify these results.

  7. Paradoxical carbon dioxide embolism during laparoscopic cholecystectomy as a cause of cardiac arrest and neurologic sequelae: a case report

    PubMed Central

    Shin, Hye Young; Kim, Dong Wook; Kim, Ju Deok; Yu, Soo Bong; Kim, Doo Sik; Kim, Kyung Han

    2014-01-01

    An 81-year-old male patient was scheduled for a laparoscopic cholecystectomy due to acute cholecystitis. About 50 minutes into the operation, the arterial blood pressure suddenly decreased and ventricular fibrillation appeared on the electrocardiography. The patient received cardiopulmonary resuscitation and recovered a normal vital sign. We suspected a carbon dioxide embolism as the middle hepatic vein had been injured during the surgery. We performed a transesophageal echocardiography and were able to confirm the presence of multiple gas bubbles in all of the cardiac chambers. After the operation, the patient presented a stable hemodynamic state, but showed weaknesses in the left arm and leg. There were no acute lesions except for a chronic cerebral cortical atrophy and chronic microvascular encephalopathy on the postoperative brain-computed tomography, 3D angiography and magnetic resonance image. Fortunately, three days after the operation, the patient's hemiparesis had entirely subsided and he was discharged without any neurologic sequelae. PMID:25558345

  8. Electrical stimulation systems for cardiac tissue engineering

    PubMed Central

    Tandon, Nina; Cannizzaro, Christopher; Chao, Pen-Hsiu Grace; Maidhof, Robert; Marsano, Anna; Au, Hoi Ting Heidi; Radisic, Milica; Vunjak-Novakovic, Gordana

    2009-01-01

    We describe a protocol for tissue engineering of synchronously contractile cardiac constructs by culturing cardiac cells with the application of pulsatile electrical fields designed to mimic those present in the native heart. Tissue culture is conducted in a customized chamber built to allow for cultivation of (i) engineered three-dimensional (3D) cardiac tissue constructs, (ii) cell monolayers on flat substrates or (iii) cells on patterned substrates. This also allows for analysis of the individual and interactive effects of pulsatile electrical field stimulation and substrate topography on cell differentiation and assembly. The protocol is designed to allow for delivery of predictable electrical field stimuli to cells, monitoring environmental parameters, and assessment of cell and tissue responses. The duration of the protocol is 5 d for two-dimensional cultures and 10 d for 3D cultures. PMID:19180087

  9. Sudden cardiac death in women.

    PubMed

    Simmons, Ashley; Pimentel, Rhea; Lakkireddy, Dhanunjaya

    2012-01-01

    Women are at lower risk for development of sudden cardiac death (SCD) as compared with men. Women with SCD tend to have less structural heart disease and preserved left ventricular systolic function. Coronary artery disease (CAD) is the most common predictor of SCD in women, as it is in men. However, women with SCD are less likely to have underlying CAD than men, suggesting the need to identify risk factors other than CAD or systolic dysfunction for its prediction in women. SCD risk factors in women include heart failure with preserved left ventricular systolic function, abnormal sympathetic uptake as assessed by meta-iodobenzylguanidine uptake, depression, and/or use of antidepressants. This article reviews SCD in women and discusses areas for future research. PMID:22565537

  10. Thrombophilia, Left Ventricular Dysfunction and Intracardiac Thrombi in Children

    PubMed Central

    Baram, Shaul; Kozer, Eran; Klin, Baruch; Eshel, Gideon

    2011-01-01

    Background and Objectives Reports on the incidence of intracardiac thrombi (ICT) have increased over the last few decades, but ICT are still relatively rare among children. Left ventricular systolic dysfunction and dilatation may contribute to the formation of ICT, especially when a hypercoagulable state exists. The aim of this study was to describe the incidence of ICT in children suffering from cardiac failure with left ventricular dysfunction and to identify risk factors on admission for developing ICT. Subjects and Methods We conducted a retrospective chart review of children up to 18 years of age admitted to the Pediatric Intensive Care Unit due to cardiac failure with left ventricular dysfunction between January 1, 2003 and December 31, 2008. Results Twenty-one patients were admitted with clinical signs of cardiac failure and echocardiographic findings compatible with dilated cardiomyopathy or acute myocarditis. Dilated cardiomyopathy was diagnosed in 11 patients (52%). Adenoviruses and enteroviruses were suspected to be the cause of acute myocarditis in 5 cases. The personal or family history of hypercoagulable states were obtained from 19 out of 21 patients (90%). Among patients with a hypercoagulable state, 3 out of 7 developed ICT compared with none out of 12 among patients without hypercoagulability (p=0.043). Two of these 3 patients experienced an embolic event. Conclusion Cardiac failure with left ventricular dysfunction may predispose the patient to ICT and increase the risk of thromboembolism, especially when an underlying hypercoagulable state exists. The hypercoagulable state must be carefully evaluated on admission in these patients. PMID:21949529

  11. Accuracy considerations in catheter based estimation of left ventricular volume

    Microsoft Academic Search

    John A. Pearce; John E. Porterfield; Erik R. Larson; Jonathan W. Valvano; Marc D. Feldman

    2010-01-01

    Cardiac volume estimation in the Left Ventricle from impedance or admittance measurement is subject to two major sources of error: parallel current pathways in surrounding tissues and a non uniform current density field. The accuracy of volume estimation can be enhanced by incorporating the complex electrical properties of myocardium to identify the muscle component in the measurement and by including

  12. Segmenting the Papillary Muscles and the Trabeculae from High Resolution Cardiac CT

    E-print Network

    Chen, Kuang-Yu

    Segmenting the Papillary Muscles and the Trabeculae from High Resolution Cardiac CT through), particularly the papillary muscles and the trabeculae. High quality segmentations of these struc- tures imaging), CT is able to show detailed anatomic structures within the cardiac chambers [15]. Recent

  13. FBG Sensor for Contact Level Monitoring and Prediction of Perforation in Cardiac Ablation

    PubMed Central

    Ho, Siu Chun Michael; Razavi, Mehdi; Nazeri, Alireza; Song, Gangbing

    2012-01-01

    Atrial fibrillation (AF) is the most common type of arrhythmia, and is characterized by a disordered contractile activity of the atria (top chambers of the heart). A popular treatment for AF is radiofrequency (RF) ablation. In about 2.4% of cardiac RF ablation procedures, the catheter is accidently pushed through the heart wall due to the application of excessive force. Despite the various capabilities of currently available technology, there has yet to be any data establishing how cardiac perforation can be reliably predicted. Thus, two new FBG based sensor prototypes were developed to monitor contact levels and predict perforation. Two live sheep were utilized during the study. It was observed during operation that peaks appeared in rhythm with the heart rate whenever firm contact was made between the sensor and the endocardial wall. The magnitude of these peaks varied with pressure applied by the operator. Lastly, transmural perforation of the left atrial wall was characterized by a visible loading phase and a rapid signal drop-off correlating to perforation. A possible pre-perforation signal was observed for the epoxy-based sensor in the form of a slight signal reversal (12–26% of loading phase magnitude) prior to perforation (occurring over 8 s). PMID:22368507

  14. Cardiac pearls.

    PubMed

    Harvey, W P

    1994-02-01

    Most diagnoses of cardiovascular disease are made in the office or at the bedside. For example, in pulsus alternans of the radial pulse, observed when first greeting a patient, alteration of intensity of the second sound and systolic murmur and a ventricular (S3) gallop are clinical pearls--often subtle--that diagnose cardiac decompensation. A faint gallop, ventricular (S3) or atrial (S4), might be overlooked in a patient who has an emphysematous chest and an increase in anteroposterior diameter if one listens over the usual areas of the precordium. However, the gallop might be detected easily by listening over the xiphoid or epigastric area. How do you tell the difference between an S4, a split first sound, and an ejection sound? The S4 is eliminated with pressure on the stethoscope, but pressure does not eliminate the ejection sound or the splitting of S1. The atrial sound (S4) is most frequently found in patients who have coronary heart disease, and it is a constant finding in patients who have hypertension. It does not denote heart failure, as does the S3 (ventricular) gallop. In some patients, both atrial (S4) and ventricular (S3) diastolic gallops may be present. This occurrence is common in patients with cardiac decompensation associated with coronary heart disease, hypertensive heart disease, and dilated cardiomyopathy. When these diastolic filling sounds occur in close proximity, a short rumbling murmur may be heard, which causes confusion of this sound with that of a valvular or congenital lesion. When both sounds occur exactly simultaneously, a single sound results. Often, this sound is louder than either the first or second sound and can be misinterpreted as either a valvular or congenital lesion. This, however, is a summation gallop, which is rare. For the most accurate timing of heart sounds and murmurs, the simple technique called "inching" is the best. Keeping the second sound in mind as a reference, the physician moves (inches) the stethoscope from the aortic area to the apex. An extra sound may be noted to occur in systole before the second sound, thereby diagnosing a systolic click. If the sound occurs after the second sound, however, it is an S3 or ventricular diastolic gallop. If a murmur appears before S2, it is a systolic murmur; if it appears after S2, it is a diastolic murmur. When the Austin-Flint murmur is heard, significant aortic regurgitation exists.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8306847

  15. Left ventricular function in chronic aortic regurgitation

    SciTech Connect

    Iskandrian, A.S.; Hakki, A.H.; Manno, B.; Amenta, A.; Kane, S.A.

    1983-06-01

    Left ventricular performance was determined in 42 patients with moderate or severe aortic regurgitation during upright exercise by measuring left ventricular ejection fraction and volume with radionuclide ventriculography. Classification of the patients according to exercise tolerance showed that patients with normal exercise tolerance (greater than or equal to 7.0 minutes) had a significantly higher ejection fraction at rest (probability (p) . 0.02) and during exercise (p . 0.0002), higher cardiac index at exercise (p . 0.0008) and lower exercise end-systolic volume (p . 0.01) than did patients with limited exercise tolerance. Similar significant differences were noted in younger patients compared with older patients in ejection fraction at rest and exercise (both p . 0.001) and cardiac index at rest (p . 0.03) and exercise (p . 0.0005). The end-diastolic volume decreased during exercise in 60% of the patients. The patients with a decrease in volume were significantly younger and had better exercise tolerance and a larger end-diastolic volume at rest than did patients who showed an increase in volume. The mean corrected left ventricular end-diastolic radius/wall thickness ratio was significantly greater in patients with abnormal than in those with normal exercise reserve (mean +/- standard deviation 476 +/- 146 versus 377 +/- 92 mm Hg, p less than 0.05). Thus, in patients with chronic aortic regurgitation: 1) left ventricular systolic function during exercise was related to age, exercise tolerance and corrected left ventricular end-diastolic radius/wall thickness ratio, and 2) the end-diastolic volume decreased during exercise, especially in younger patients and patients with normal exercise tolerance or a large volume at rest.

  16. Transseptal fine needle aspiration of a large left atrial tumour.

    PubMed

    Wong, Chi Wing; Ruygrok, Peter; Sutton, Timothy; Ding, Patricia; van Vliet, Chris; Occleshaw, Christopher; Smith, Warren

    2010-07-01

    The diagnosis of cardiac tumours is often based on images without tissue diagnosis or tissue obtained at surgery. Percutaneous myocardial biopsy via a transvenous approach has been described in literatures but this technique is not feasible with left atrial tumours. We report a patient presenting with heart failure and left atrial tumour. The diagnosis of spindle cell neoplasm was established pre-operatively via successful transseptal fine needle aspiration of cells from a left atrial tumour. We believe this technique worth consideration to aid pre-surgery diagnosis. PMID:19656723

  17. Clinical usefulness of the cardiac multi-detector-row CT.

    PubMed

    Mochizuki, Teruhito; Higashino, Hiroshi; Koyama, Yasushi; Hosoi, Satosi; Tsuda, Takaharu; Sugawara, Yoshifumi; Miyagawa, Masao; Ikezoe, Junpei; Shen, Yun

    2003-01-01

    Along with improvement of the temporal and special resolution, multi-detector-row CT has become able to generate artifact-less heart images. We discuss the potential benefits of the newly developed cardiac application, demonstrating informative cases.Two- and three-dimensional (2D and 3D) cardiac images were produced throughout one cardiac cycle. By paging 2D and 3D images in cardiac cycle order, animated movies were generated. Cardiac imaging with multi-detector-row CT, acquired during a single breath hold, provides information about: (1) clear morphology of heart chambers and myocardium, (2) wall motion and systolic thickening, (3) myocardial perfusion, (4) volume assessment, and (5) coronary anatomy and pathophysiology. PMID:12573888

  18. Solar thermal plasma chamber

    NASA Astrophysics Data System (ADS)

    Bonometti, Joseph; Buchele, Donald R.; Castle, Charles H.; Gregory, Don A.

    2001-11-01

    A unique solar thermal chamber has been designed and fabricated to produce the maximum concentration of solar energy and highest temperature possible. Its primary purpose was for solar plasma propulsion experiments and related material specimen testing above 3000 Kelvin. The design not only maximized solar concentration, but also, minimized infrared heat loss. This paper provides the underlining theory and operation of the chamber and initial optical correlation to the actual fabricated hardware. The chamber is placed at the focal point of an existing primary concentrator with a 2.74-meter (9 foot) focal length. A quartz lens focuses a smaller sun image at the inlet hole of the mirrored cavity. The lens focuses two image planes at prescribed positions; the sun at the cavity's entrance hole, and the primary concentrator at the junction plane of two surfaces that form the cavity chamber. The back half is an ellipsoid reflector that produces a 1.27 cm diameter final sun image. The image is 'suspended in space' 7.1cm away from the nearest cavity surface, to minimize thermal and contaminate damage to the mirror surfaces. A hemisphere mirror makes up the front chamber and has its center of curvature at the target image, where rays leaving the target are reflected back upon themselves, minimizing radiation losses.

  19. Echocardiographic assessment of the cardiac amyloidoses.

    PubMed

    Koyama, Jun; Ikeda, Shu-Ichi; Ikeda, Uichi

    2015-03-25

    Cardiac amyloidosis is a cardiomyopathy characterized by increased left ventricular (LV) wall thickness and normal or decreased LV cavity size. Congestive heart failure in cardiac amyloidosis is generally considered a predominantly diastolic phenomenon, with systolic dysfunction only occurring in late-stage disease. Echocardiography is a noninvasive, reproducible method of assessing cardiac features and function in cardiac amyloidosis, and some echocardiographic indices are prognostic for the amyloidoses, with M-mode and 2-dimensional echocardiography able to detect increased LV wall thickness. Moreover, Doppler flow measurements can incrementally assess diastolic LV dysfunction, which is characteristic of cardiac amyloidosis, and provide important prognostic information. Additionally, tissue Doppler imaging can detect subtle changes in both systolic and diastolic LV function, which cannot be detected by Doppler flow measurements, and LV longitudinal strain assessed by color tissue Doppler and speckle tracking echocardiography can provide more accurate LV functional and prognostic information than tissue Doppler imaging. This review describes the advances in echocardiography and its crucial role in the diagnosis and management of cardiac amyloidosis. (Circ J 2015; 79: 721-734). PMID:25766406

  20. Automated Electrostatics Environmental Chamber

    NASA Technical Reports Server (NTRS)

    Calle, Carlos; Lewis, Dean C.; Buchanan, Randy K.; Buchanan, Aubri

    2005-01-01

    The Mars Electrostatics Chamber (MEC) is an environmental chamber designed primarily to create atmospheric conditions like those at the surface of Mars to support experiments on electrostatic effects in the Martian environment. The chamber is equipped with a vacuum system, a cryogenic cooling system, an atmospheric-gas replenishing and analysis system, and a computerized control system that can be programmed by the user and that provides both automation and options for manual control. The control system can be set to maintain steady Mars-like conditions or to impose temperature and pressure variations of a Mars diurnal cycle at any given season and latitude. In addition, the MEC can be used in other areas of research because it can create steady or varying atmospheric conditions anywhere within the wide temperature, pressure, and composition ranges between the extremes of Mars-like and Earth-like conditions.

  1. Automated soil gas monitoring chamber

    DOEpatents

    Edwards, Nelson T.; Riggs, Jeffery S.

    2003-07-29

    A chamber for trapping soil gases as they evolve from the soil without disturbance to the soil and to the natural microclimate within the chamber has been invented. The chamber opens between measurements and therefore does not alter the metabolic processes that influence soil gas efflux rates. A multiple chamber system provides for repetitive multi-point sampling, undisturbed metabolic soil processes between sampling, and an essentially airtight sampling chamber operating at ambient pressure.

  2. Filament wound rocket motor chambers

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The design, analysis, fabrication and testing of a Kevlar-49/HBRF-55A filament wound chamber is reported. The chamber was fabricated and successfully tested to 80% of the design burst pressure. Results of the data reduction and analysis from the hydrotest indicate that the chamber design and fabrication techniques used for the chamber were adequate and the chamber should perform adequately in a static test.

  3. Apparent distance of sounds recorded in echoic and anechoic chambers

    Microsoft Academic Search

    Robert A. Butler; Elena T. Levy; William D. Neff

    1980-01-01

    With miniature microphones inserted into the external ear canals of a model and the sound source 90° to left of midline, low-pass, and high-pass, broadband noise bursts were picked up and recorded on magnetic tape. The bursts were generated in 2 highly contrasting acoustic environments: an anechoic and an echoic chamber. The taped sounds were played back monaurally and binaurally

  4. 11. GENERAL VIEW IN SENATE CHAMBER, FROM WEST; PAINTED GLASS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. GENERAL VIEW IN SENATE CHAMBER, FROM WEST; PAINTED GLASS WINDOW BEHIND COLUMNS DEPICTS 'THE LANDING OF DE SOTO;' MURAL TO LEFT SHOWS 'THOMAS HART BENTON'S SPEECH AT ST. LOUIS 1849;' MURAL TO RIGHT SHOWS 'PRESIDENT JEFFERSON GREETING LEWIS AND CLARK' - Missouri State Capitol, High Street between Broadway & Jefferson Streets, Jefferson City, Cole County, MO

  5. 78. (Credit JTL) Mixing chambers (19241926) in foreground, looking west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    78. (Credit JTL) Mixing chambers (1924-1926) in foreground, looking west along south facade of station. Settling basins to left, new filter house (1942) in background. Aerators added in 1930-31 to remove carbon dioxide from water. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

  6. Novel approach for the percutaneous treatment of left ventricular pseudoaneurysms.

    PubMed

    Singh, Ayushi; Kliger, Chad; Ruiz, Carlos E

    2015-05-01

    Left ventricular pseudoaneurysm (LVPA) is a rare yet serious complication that may follow cardiac surgery, myocardial infarction, trauma, or infection. If left untreated, reported rates of rupture and sudden cardiac death are high. Although surgical intervention has traditionally been the standard treatment for LVPA, percutaneous closure is now an attractive alternative in the high-risk patient. We report a case of a successful percutaneous LVPA closure using direct chest wall entry into the pseudoaneurysm. This novel approach can be useful when access to the LVPA is a challenge, especially in the setting of small ostial size, dense left ventricular trabeculations, angulated serpiginous tract, and presence of mechanical prostheses. © 2014 Wiley Periodicals, Inc. PMID:25533813

  7. Glycogen Synthase Kinase-3? Limits Ischemic Injury, Cardiac Rupture, Post–Myocardial Infarction Remodeling and Death

    PubMed Central

    Lal, Hind; Zhou, Jibin; Ahmad, Firdos; Zaka, Raihana; Vagnozzi, Ronald J.; DeCaul, Morgan; Woodgett, James; Gao, Erhe; Force, Thomas

    2015-01-01

    Background The molecular pathways that regulate the extent of ischemic injury and post–myocardial infarction (MI) remodeling are not well understood. We recently demonstrated that glycogen synthase kinase-3? (GSK-3?) is critical to the heart’s response to pressure overload. However, the role, if any, of GSK-3? in regulating ischemic injury and its consequences is not known. Methods and Results MI was induced in wild-type (WT) versus GSK-3?(?/?) (KO) littermates by left anterior descending coronary artery ligation. Pre-MI, WT, and KO hearts had comparable chamber dimensions and ventricular function, but as early as 1 week post-MI, KO mice had significantly more left ventricular dilatation and dysfunction than WT mice. KO mice also had increased mortality during the first 10 days post-MI (43% versus 22%; P=0.04), and postmortem examination confirmed cardiac rupture as the cause of most of the deaths. In the mice that survived the first 10 days, left ventricular dilatation and dysfunction remained worse in the KO mice throughout the study (8 weeks). Hypertrophy, fibrosis, and heart failure were all increased in the KO mice. Given the early deaths due to rupture and the significant reduction in left ventricular function evident as early as 1 week post-MI, we examined infarct size following a 48-hour coronary artery ligation and found it to be increased in the KO mice. This was accompanied by increased apoptosis in the border zone of the MI. This increased susceptibility to ischemic injury–induced apoptosis was also seen in cardiomyocytes isolated from the KO mice that were exposed to hypoxia. Finally, Bax translocation to the mitochondria and cytochrome C release into the cytosol were increased in the KO mice. Conclusion GSK-3? confers resistance to ischemic injury, at least in part, via limiting apoptosis. Loss of GSK-3? promotes ischemic injury, increases risk of cardiac rupture, accentuates post-MI remodeling and left ventricular dysfunction, and increases the progression to heart failure. These findings are in striking contrast to multiple previous reports in which deletion or inhibition of GSK-3? is protective. PMID:22086876

  8. Multiple piston expansion chamber engine

    SciTech Connect

    Jackson, F.W.

    1988-05-03

    The method of operation for the extraction of work from combusted products in two chambers hereafter referred to as working and auxiliary having a means of controlling isolation between the two the chambers is described comprising of isolating the working chamber from the auxiliary chamber when the working chamber piston is at substantially TDC, admitting a charge of pressurized carbureted air into the working chamber as the working chamber piston moves toward BDC, closing a valve admitting the charge after the working chamber piston is past BDC but before it is midway to TDC, compressing the charge in the working chamber, initiating combustion of the charge prior to the working chamber piston passing TDC, expanding the combusted products in the working chamber unit a point in the cycle after combustion is completed and before the working chamber piston is within 60 degrees of BDC, and expansion of the combusted products in the working chamber piston chamber prior to establishing communication between the working and auxiliary chambers shall not exceed four.

  9. Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia.

    PubMed

    Akiyama, Koichi; Arisawa, Shoji; Ide, Masahiro; Iwaya, Masaaki; Naito, Yoshiyuki

    2013-06-01

    Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images. PMID:23404310

  10. Cardiac atrophy after bed-rest deconditioning: a nonneural mechanism for orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Levine, B. D.; Zuckerman, J. H.; Pawelczyk, J. A.; Blomqvist, C. G. (Principal Investigator)

    1997-01-01

    BACKGROUND: The cardiovascular adaptation to bed rest leads to orthostatic intolerance, characterized by an excessive fall in stroke volume (SV) in the upright position. We hypothesized that this large fall in SV is due to a change in cardiac mechanics. METHODS AND RESULTS: We measured pulmonary capillary wedge pressure (PCWP), SV, left ventricular end-diastolic volume (LVEDV), and left ventricular mass (by echocardiography) at rest, during lower-body negative pressure, and after saline infusion before and after 2 weeks of bed rest with -6 degrees head-down tilt (n=12 subjects aged 24+/-5 years). Pressure (P)-volume (V) curves were modeled exponentially by P=ae(kV)+b and logarithmically by P=-Sln[(Vm-V)/(Vm-V0)], where V0 indicates volume at P=0, and the constants k and S were used as indices of normalized chamber stiffness. Dynamic stiffness (dP/dV) was calculated at baseline LVEDV. The slope of the line relating SV to PCWP during lower-body negative pressure characterized the steepness of the Starling curve. We also measured plasma volume (with Evans blue dye) and maximal orthostatic tolerance. Bed rest led to a reduction in plasma volume (17%), baseline PCWP (18%), SV (12%), LVEDV (16%), V0 (33%), and orthostatic tolerance (24%) (all P<.05). The slope of the SV/PCWP curve increased from 4.6+/-0.4 to 8.8+/-0.9 mL/mm Hg (P<.01) owing to a parallel leftward shift in the P-V curve. Normalized chamber stiffness was unchanged, but dP/dV was reduced by 50% at baseline LVEDV, and cardiac mass tended to be reduced by 5% (P<.10). CONCLUSIONS: Two weeks of head-down-tilt bed rest leads to a smaller, less distensible left ventricle but a shift to a more compliant portion of the P-V curve. This results in a steeper Starling relationship, which contributes to orthostatic intolerance by causing an excessive reduction in SV during orthostasis.

  11. Transcatheter device closure of a congenital aortic-left atrial tunnel.

    PubMed

    Sun, Heather Y; Buccola, Katie Jo; Punn, Rajesh; Silverman, Norman H; Peng, Lynn F; Perry, Stanton B; Balasubramanian, Sowmya

    2014-01-01

    Rare cases of aortic-left atrial tunnel exist in the literature. This case report highlights the echocardiographic characterization of this vascular anomaly and provides the first description of an aortic-left atrial tunnel closed by interventional cardiac catheterization in a pediatric patient. PMID:23601836

  12. Congenital absence of left atrial appendage: A case report and literature review

    PubMed Central

    Ghori, M.A.; Alessandro, Salustri

    2014-01-01

    Congenital absence of left atrial appendage (LAA) is an extremely rare entity. A 50-year-old man with no past cardiac history was admitted with symptomatic atrial fibrillation (AF). Before subjecting him to direct current (DC) cardioversion, the patient underwent a transesophageal echocardiography (TEE) examination, but neither LAA nor a cardiac thrombus could be detected. Absence of both was confirmed by cardiac computer tomography (CT) and a cardiac magnetic resonance imaging (MRI) scan. The patient reverted to sinus rhythm with an uneventful synchronized biphasic DC shock of 100 joules.

  13. Left Business Observer

    NSDL National Science Digital Library

    Edited by Wall Street author Doug Henwood, the Left Business Observer site features selected articles from the print journal by the same name (1992-present). The site provides special reports on current political issues, in addition to a discussion forum and US labor statistics with commentary from a "left" perspective.

  14. Coding left and right

    Microsoft Academic Search

    William S. Farrell

    1979-01-01

    Compared the processing of direction for up and down and left and right arrows in visual displays. 64 undergraduates took part in 5 experiments. Exp I demonstrated that it is more difficult to deal with left and right than with up and down when differentiating between the two directions than when orienting to them. Exps II and III showed that

  15. Left sided Amyand's hernia.

    PubMed

    Malik, Kamran Ahmad

    2010-07-01

    Appendicitis within an Amyand's hernia is a rare clinical entity in itself and becomes especially more rare if it occurs in the left inguinal region. We report this rare case of Amyand's hernia where the appendix was found along with gangrenous ceacum during surgery for strangulated left inguinal hernia in an adult, who underwent resection, anastomosis and simple repair for his hernia. PMID:20642952

  16. Cardiac conduction system

    MedlinePLUS Videos and Cool Tools

    ... cardiac muscle cells in the walls of the heart that send signals to the heart muscle causing it to contract. The main components ... the cardiac conduction system’s electrical activity in the heart.

  17. Extracellular Matrix Roles During Cardiac Repair

    PubMed Central

    Jourdan-LeSaux, Claude; Zhang, Jianhua; Lindsey, Merry L.

    2010-01-01

    The cardiac extracellular matrix (ECM) provides a platform for cells to maintain structure and function, which in turn maintains tissue function. In response to injury, the ECM undergoes remodeling that involves synthesis, incorporation, and degradation of matrix proteins, with the net outcome determined by the balance of these processes. The major goals of this review are a) to serve as an initial resource for students and investigators new to the cardiac ECM remodeling field, and b) to highlight a few of the key exciting avenues and methodologies that have recently been explored. While we focus on cardiac injury and responses of the left ventricle (LV), the mechanisms reviewed here have pathways in common with other wound healing models. PMID:20670633

  18. CARDIAC COMPLICATIONS OF CHEMOTHERAPY: ROLE OF IMAGING

    PubMed Central

    Tan, Timothy C.; Scherrer-Crosbie, Marielle

    2014-01-01

    Opinion Statement New advances in cancer diagnosis and treatment have increased survival rates in patients with cancer. In parallel with the increase in the number of cancer survivors is an increasing prevalence of cardiac complications from cancer treatment. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. Evidence suggests that both clinical symptoms and the traditional left ventricular ejection fraction (LVEF) may lack sensitivity as measures of cardiotoxicity. The early identification of subclinical LV dysfunction is becoming increasingly important, as this may allow cancer patients and their physicians to make informed decisions about therapeutic options. The features of echocardiography make it a useful tool in the diagnosis and monitoring of cardiotoxicity. This review will examine the role of cardiac imaging in detecting cardiotoxicity, focusing primarily on the conventional and more recent echocardiographic approaches for assessing subclinical cardiotoxicity. PMID:24519487

  19. Left Atrial Anatomy Relevant to Catheter Ablation

    PubMed Central

    Sánchez-Quintana, Damián; Cabrera, José Angel; Saremi, Farhood

    2014-01-01

    The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. PMID:25057427

  20. Sebastian Sager, Florian Kehrle, Eberhard Scholz Decoding complex cardiac arrhythmia

    E-print Network

    Boyer, Edmond

    Arrhythmia hal-01024634,version1-18Jul2014 #12;Outline 1 Medical Problem 2 Mathematical Approaches 3 Inverse Results and Summary 3 S. Sager | Cardiac Arrhythmia hal-01024634,version1-18Jul2014 #12;Reminder-01024634,version1-18Jul2014 #12;Reminder: the human heart [Images: Wikipedia] Atrial chambers 4 S. Sager

  1. Cardiac sodium channelopathies

    Microsoft Academic Search

    Ahmad S. Amin; Alaleh Asghari-Roodsari; Hanno L. Tan

    2010-01-01

    Cardiac sodium channel are protein complexes that are expressed in the sarcolemma of cardiomyocytes to carry a large inward\\u000a depolarizing current (INa) during phase 0 of the cardiac action potential. The importance of INa for normal cardiac electrical activity is reflected by the high incidence of arrhythmias in cardiac sodium channelopathies,\\u000a i.e., arrhythmogenic diseases in patients with mutations in SCN5A,

  2. Liquid Wall Chambers

    SciTech Connect

    Meier, W R

    2011-02-24

    The key feature of liquid wall chambers is the use of a renewable liquid layer to protect chamber structures from target emissions. Two primary options have been proposed and studied: wetted wall chambers and thick liquid wall (TLW) chambers. With wetted wall designs, a thin layer of liquid shields the structural first wall from short ranged target emissions (x-rays, ions and debris) but not neutrons. Various schemes have been proposed to establish and renew the liquid layer between shots including flow-guiding porous fabrics (e.g., Osiris, HIBALL), porous rigid structures (Prometheus) and thin film flows (KOYO). The thin liquid layer can be the tritium breeding material (e.g., flibe, PbLi, or Li) or another liquid metal such as Pb. TLWs use liquid jets injected by stationary or oscillating nozzles to form a neutronically thick layer (typically with an effective thickness of {approx}50 cm) of liquid between the target and first structural wall. In addition to absorbing short ranged emissions, the thick liquid layer degrades the neutron flux and energy reaching the first wall, typically by {approx}10 x x, so that steel walls can survive for the life of the plant ({approx}30-60 yrs). The thick liquid serves as the primary coolant and tritium breeding material (most recent designs use flibe, but the earliest concepts used Li). In essence, the TLW places the fusion blanket inside the first wall instead of behind the first wall.

  3. Flame-Test Chamber

    NASA Technical Reports Server (NTRS)

    Bjorklund, R. A.

    1984-01-01

    Experimental chamber provides controlled environment for observation and measurement of flames propagating in expanding plume of flammable air/fuel mixture under atmospheric conditions. Designed to evaluate quenching capability of screen-type flame arresters in atmospheric vents of fuel cargo tanks aboard marine cargo vessels.

  4. Spark Chamber Pulsing System

    Microsoft Academic Search

    Louis Lavoie; Sherwood Parker; Charles Rey; Daniel M. Schwartz

    1964-01-01

    A spark chamber pulser is described in which several avalanche transistors and a step-up transformer drive directly an air spark gap whose trigger electrode is surrounded by barium titanate dielectric. Output pulses of from 1 to 25 kV with a risetime of 1 nsec and an output impedance of less than 1 ? can be obtained. The total delay from

  5. Solar thermal plasma chamber

    Microsoft Academic Search

    Joseph Bonometti; Donald R. Buchele; Charles H. Castle; Don A. Gregory

    2001-01-01

    A unique solar thermal chamber has been designed and fabricated to produce the maximum concentration of solar energy and highest temperature possible. Its primary purpose was for solar plasma propulsion experiments and related material specimen testing above 3000 Kelvin. The design not only maximized solar concentration, but also, minimized infrared heat loss. This paper provides the underlining theory and operation

  6. Improved wire chamber

    DOEpatents

    Atac, M.

    1987-05-12

    An improved gas mixture for use with proportional counter devices, such as Geiger-Mueller tubes and drift chambers. The improved gas mixture provides a stable drift velocity while eliminating wire aging caused by prior art gas mixtures. The new gas mixture is comprised of equal parts argon and ethane gas and having approximately 0.25% isopropyl alcohol vapor. 2 figs.

  7. Doppler evaluation of cardiac filling and ejection properties in humans during parabolic flight.

    PubMed

    Johns, J P; Vernalis, M N; Karemaker, J M; Latham, R D

    1994-06-01

    The cardiac filling and ejection properties of seven normal human subjects were examined during microgravity created on a National Aeronautics and Space Administration aircraft during parabolic flight. Doppler echocardiography was used to measure intracardiac velocities in sitting and supine subjects during three phases of flight: hypergravity (phase I), early microgravity (phase III), and late microgravity (phase IV). Heart rate declined 6% (P < 0.001) and right ventricular inflow velocities rose (46%, early; 26%, mean; P < 0.01) between phase I and phases III or IV in the sitting position only. Peak left ventricular outflow velocities rose 12% and inflow velocities rose (13%, early; 20%, mean) between phases I and IV while subjects were in the supine position (P < 0.05). A 14% rise in early velocities alone was seen between phases I and IV while subjects were in the sitting position (P < 0.05). In subjects entering microgravity while sitting, right heart chambers can accept additional venous return. When microgravity was entered while subjects were supine, however, venous augmentation was not observed. Left heart filling was more prominently enhanced when microgravity was entered while subjects were supine, suggesting a shift of fluid within the pulmonary vasculature. PMID:7928892

  8. Validation of a peak endocardial acceleration-based algorithm to optimize cardiac resynchronization: early clinical results

    PubMed Central

    Delnoy, Peter Paul; Marcelli, Emanuela; Oudeluttikhuis, Henk; Nicastia, Deborah; Renesto, Fabrizio; Cercenelli, Laura; Plicchi, Gianni

    2008-01-01

    Aims Cardiac resynchronization therapy (CRT) involves time-consuming procedures to achieve an optimal programming of the system, at implant as well as during follow-up, when remodelling occurs. A device equipped with an implantable sensor able to measure peak endocardial acceleration (PEA) has been recently developed to monitor cardiac function and to guide CRT programming. During scanning of the atrioventricular delay (AVD), PEA reflects both left ventricle (LV) contractility (LV dP/dtmax) and transmitral flow. A new CRT optimization algorithm, based on recording of PEA (PEAarea method) was developed, and compared with measurements of LV dP/dtmax, to identify an optimal CRT configuration. Methods and results We studied 15 patients in New York Heart Association classes II–IV and with a QRS duration >130 ms, who had undergone implantation of a biventricular (BiV) pulse generator connected to a right ventricular (RV) PEA sensor. At a mean of 39 ± 15 days after implantation of the CRT system, the patients underwent cardiac catheterization. During single-chamber LV or during BiV stimulation, with initial RV or LV stimulation, and at settings of interventricular intervals between 0 and 40 ms, the AVD was scanned between 60 and 220 ms, while LV dP/dtmax and PEA were measured. The area of PEA curve (PEAarea method) was estimated as the average of PEA values measured during AVD scanning. A ?10% increase in LV dP/dtmax was observed in 12 of 15 patients (80%), who were classified as responders to CRT. In nine of 12 responders (75%), the optimal pacing configuration identified by the PEAarea method was associated with the greatest LV dP/dtmax. Conclusion The concordance of the PEAarea method with measurements of LV dP/dtmax suggests that this new, operator-independent algorithm is a reliable means of CRT optimization. PMID:18492682

  9. Echocardiography in cardiac amyloidosis.

    PubMed

    Falk, Rodney H; Quarta, C Cristina

    2015-03-01

    Echocardiography is the most widely used noninvasive test in patients with heart failure or abnormal cardiac findings on examination. Patients with amyloidosis may have significant cardiac abnormalities, several of which are highly suggestive of the disease. This article reviews echocardiographic features found in cardiac amyloidosis. PMID:25597027

  10. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    NASA Astrophysics Data System (ADS)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  11. Multi-chamber deposition system

    DOEpatents

    Jacobson, Richard L. (Roseville, MN); Jeffrey, Frank R. (Shoreview, MN); Westerberg, Roger K. (Cottage Grove, MN)

    1989-10-17

    A system for the simultaneous deposition of different coatings onto a thin web within a large volume vacuum chamber is disclosed which chamber is provided with a plurality of deposition chambers in which the different layers are deposited onto the film as its moves from a supply roll to a finished take-up roll of coated web. The deposition chambers provided within the large vacuum chamber are provided with separate seals which minimize back diffusion of any dopant gas from adjacent deposition chambers.

  12. Multi-chamber deposition system

    DOEpatents

    Jacobson, Richard L. (Roseville, MN); Jeffrey, Frank R. (Shoreview, MN); Westerberg, Roger K. (Cottage Grove, MN)

    1989-06-27

    A system for the simultaneous deposition of different coatings onto a thin web within a large volume vacuum chamber is disclosed which chamber is provided with a plurality of deposition chambers in which the different layers are deposited onto the film as its moves from a supply roll to a finished take-up roll of coated web. The deposition chambers provided within the large vacuum chamber are provided with separate seals which minimize back diffusion of any dopant gas from adjacent deposition chambers.

  13. Ventricular hemodynamics using cardiac computed tomography and optical flow method.

    PubMed

    Lin, Yang-Hsien; Huang, Yung-Hui; Lin, Kang-Ping; Liu, Juhn-Cherng; Huang, Tzung-Chi

    2014-01-01

    Ventricular hemodynamics plays an important role in assessing cardiac function in clinical practice. The aim of this study was to determine the ventricular hemodynamics based on contrast movement in the left ventricle (LV) between the phases in a cardiac cycle recorded using an electrocardiography (ECG) with cardiac computed tomography (CT) and optical flow method. Cardiac CT data were acquired at 120 kV and 280 mA with a 350 ms gantry rotation, which covered one cardiac cycle, on the 640-slice CT scanner with ECG for a selected patient without heart disease. Ventricular hemodynamics (mm/phase) were calculated using the optical flow method based on contrast changes with ECG phases in anterior-posterior, lateral and superior-inferior directions. Local hemodynamic information of the LV with color coating was presented. The visualization of the functional information made the hemodynamic observation easy. PMID:24463391

  14. [Cardiac failure in a child during anesthetic induction with sevoflurane].

    PubMed

    Oto, Hirotaka; Nakamura, Tadaho; Nakamura, Kyouichi; Tani, Makiko; Kobayashi, Osamu; Takahashi, Yukio

    2006-09-01

    A five-year-old boy with recurring tonsillitis and sleep apnea was admitted for tonsillectomy and tympanic membrane tubing. He presented with a history of bronchial asthma and hereditary spherocytosis without obvious cardiac failure symptoms. Anesthetic agents for induction included nitrous oxide, oxygen, and sevoflurane. Because oxygen saturation decreased immediately to 90%, tracheal intubation was performed. The patient began to wheeze. Sevoflurane concentration was increased but cardiac murmur (gallop), cold limbs and jugular vein distension were noted. Acute cardiac failure was diagnosed following a chest X-ray and cardiac echo showing an enlarged heart, CTR of 80%, left ventricular dilation, and contractile failure. Tympanic membrane tubing only was performed. Sevoflurane was discontinued and the patient was treated for the cardiac failure under an ICU oxygen tent. The patient was discharged when his general condition improved. He showed elevated levels of viral antibodies, suggesting myocarditis. Later he was treated for dilating cardiomyopathy before undergoing a heart transplant. PMID:16984022

  15. Determinants of Right Ventricular Muscle Mass in Idiopathic Dilated Cardiomyopathy: Impact of Left Ventricular Muscle Mass and Pulmonary Hypertension

    PubMed Central

    Vormbrock, Julia; Liebeton, Jeanette; Wirdeier, Sophia; Meissner, Axel; Butz, Thomas; Trappe, Hans-Joachim; Plehn, Gunnar

    2014-01-01

    Introduction: Although chronic pulmonary hypertension and right ventricular (RV) function carry important functional and prognostic implications in idiopathic dilated cardiomyopathy (IDC), little information on RV muscle mass (RVMM) and its determinants has been published. Methods: Our study comprised thirty-five consecutive patients with IDC, left ventricular (LV) ejection fraction <40% and NYHA class ?2. Hemodynamic data and parameters on LV and RV geometry were derived from right heart catheterisation and cardiac magnetic resonance imaging. Results: RVMM was normalized to body size using a common linear, body surface area based approach (RVMMI) and by an allometric index (RVMM-AI) incorporating adjustment for age, height and weight. Stepwise multiple regression analysis revealed that pulmonary artery pressure and left ventricular muscle mass were independent predictors of RVMM-AI. The interventricular mass ratio of RV and LV mass (IVRM) was closely related to RVMM (r = 0.79, p < 0.001) and total muscle mass (r = 0.39, p < 0.02). However, there was no significant relationship between LVMM and IVMR (r = 0.17, p = 0.32). Conclusion: Our data suggest that an increase in RV mass in IDC may be explained by two mechanisms: First, as a consequence of the myopathic process itself resulting in a balanced hypertrophy of both ventricles. Second, due to the chamber specific burden of pulmonary artery pressure rise, resulting in unbalanced RV hypertrophy. PMID:24936147

  16. Serial hemodynamic assessment using Doppler echocardiography in a fetus with left ventricular aneurysm presented as fetal hydrops.

    PubMed

    Hirose, A; Maeno, Y; Suda, K; Fusazaki, N; Kado, H; Matsuishi, T

    2013-06-01

    A 22-week fetus presented with a large left ventricular aneurysm, 24 × 21 × 18 mm in size, detected by abnormal four-chamber view, and severe fetal hydrops with pericardial effusion, ascites and skin edema. The aneurysm was thin-walled, hypokinetic, and had enlarged with gestational age, causing compression of the lung. Although the left ventricular function had progressively impaired as expressed by increase in Tei index, hydrops had resolved by 32 weeks of gestation, probably because of maternal digoxin therapy and successful compensation by the right ventricle, as represented by retrograde blood flow in the distal aortic arch via the patent arterial duct. Because of the significant risk of severe cardiorespiratory failure, we transported the mother to a neonatal cardiac surgical center at 38 weeks of gestation. Indeed, the baby showed severe cardiopulmonary failure after birth, showing 100% of cardiothoracic ratio on the chest X-ray film, but was saved by the successful Dor procedure, including surgical resection of the aneurysm at 10 h of life. In this case, serial echocardiographic evaluation can allow us to monitor the hemodynamics and lead to successful postnatal management. PMID:23719251

  17. Sudden cardiac death: a modern pathology approach to hypertrophic cardiomyopathy.

    PubMed

    Kocovski, Linda; Fernandes, John

    2015-03-01

    Hypertrophic cardiomyopathy is one of the most common causes of sudden cardiac death among young adults and adolescents. Unfortunately, the first manifestation of the condition may be sudden death during exertion, such as sporting activities. Other clinical symptoms include exertional dyspnea, angina, and syncope. Postmortem examination often reveals asymmetrical septal thickening and mural plaque formation in the left ventricular outflow tract. Histologic analysis shows cardiac myocyte hypertrophy, myofiber disarray, and interstitial and replacement fibrosis. Molecular analysis for known genetic abnormalities is essential to genetic counseling of living relatives of decedents to assess and reduce the risk of sudden cardiac death from hypertrophic cardiomyopathy. PMID:25724039

  18. Cardiac disease after radiation therapy for Hodgkin's disease: analysis of 48 patients

    SciTech Connect

    Applefeld, M.M.; Wiernik, P.H.

    1983-06-01

    Occult or overt but delayed cardiac disease after thoracic radiotherapy for Hodgkin's disease may be common. Detailed cardiac evaluations were performed in 48 patients with Hodgkin's disease at risk a mean of 97 months after radiotherapy. The study protocol included echocardiography, gated radionuclide ventriculography, and cardiac catheterization. Cardiac disease was found in 46 patients (96%) and included constrictive or occult constrictive pericarditis (24 patients), an abnormal hemodynamic response to a fluid challenge (14 patients), coronary artery disease (6 patients), and left ventricular dysfunction (2 patients). Most patients (53%) had normal echocardiograms. Gated blood pool radionuclide angiocardiography was performed in 42 patients. Excluding patients with occlusive coronary artery disease, the left ventricular ejection fraction at rest (mean 59%) and during exercise (mean 69%) was within normal limits. Thus (1) delayed cardiac disease after radiotherapy is common, (2) chronic pericardial disorders are the most frequent manifestations of this disease, and (3) the prognosis for patients who have radiation-induced cardiac disease is generally favorable.

  19. Epicardial Automatic Implantable Cardiac Defibrillator In A Child With Symptomatic Bugada Syndrome

    PubMed Central

    Moltedo, Jose M; Abello, Mauricio; Gustavo, Sivori; Javier, Celada; Delucis, Pablo Garcia

    2011-01-01

    An 18 month old 14 kg male with symptomatic Brugada syndrome underwent placement of an epicardial automatic implantable cardiac defibrillator using a single coil transvenous lead sutured to the anterolateral aspect of the left ventricle. PMID:21760684

  20. Mediastinal diffuse large B-cell lymphoma invading the left atrium mimicking coronary artery disease with a mural thrombus.

    PubMed

    Yang, Chih-Chun; Tsai, Hung-Wen; Lai, Szu-Tsen; Wu, Hui Chung; Lo, Chung-Yu; Chang, Yen

    2012-11-01

    A left atrial mass associated with coronary artery disease is often diagnosed as a mural thrombus rather than other possible etiologies such as benign primary cardiac tumor (myxoma, lipoma), a malignant primary cardiac tumor (sarcoma, lymphoma), or secondary involvement for extracardiac tumors. Malignant lymphoma initially presenting as intracardiac masses is very rare. Chest computed tomography with contrast enhancement and cardiac magnetic resonance may be the best methods for distinguishing primary cardiac tumors from direct extension from adjacent mediastinal structures. We report the case of a 59-year-old man with incidentally found mediastinal diffuse large B-cell lymphoma invading the left atrium, which presented with coronary artery disease and a left atrial mass. Improvement in cardiac ventricular function heart after coronary artery bypass grafting may provide the patient with a better chance of receiving an adequate dose of chemotherapy. PMID:23158040

  1. Peripheral venous scintillation angiocardiography in determination of left ventricular volume in man.

    NASA Technical Reports Server (NTRS)

    Sullivan, R. W.; Bergeron, D. A.; Vetter, W. R.; Hyatt, K. H.; Haughton, V.; Vogel, J. M.

    1971-01-01

    Left ventricular end-diastolic volume was determined by cardiac visualization after peripheral venous injection of a gamma-emitting isotope in 10 patients with organic heart disease. The left ventricular end-diastolic volume measured by the isotope method consistently averaged 9% less than that determined by the X-ray method. The mean difference in left ventricular end-diastolic volume was 21 ml. Excellent correlation between the two methods was observed. It is pointed out that peripheral venous scintillation angiocardiography compares well with left ventriculography in the determination of left ventricular end-diastolic volume in man.

  2. Late onset oral treatment with tranilast following large myocardial infarction has no beneficial effects on cardiac remodeling and mortality in rats.

    PubMed

    Betge, Stefan; Kunz, Christian; Figulla, Hans; Jung, Christian

    2014-12-01

    Tranilast (Tra) reduces intracardiac interstitial fibrosis in the animal models of hypertensive heart failure and diabetic cardiomyopathy by inhibiting cardiac fibroblasts. The present study examined whether Tra has long-term effects on the cardiac remodeling in the remote area of the left ventricle (LV) following myocardial infarction (MI) in the rat. Treatment with Tra (n=40; 150 mg/kg twice daily) or placebo (Plac, n=36) was started at day 28 after induction of a large MI or sham-operation (ShO, n=18) in female Lewis rats. Collagen content was determined using high-performance liquid chromatography. Large MI led to a significant hypertrophy of the two ventricles, a severe dilatation of the LV and a shift of the chamber stiffness variables in the pressure volume curves. The six-month survival rates were Tra, 62.5%; Plac, 75%; and ShO, 100%. No significant difference was identified between Tra and Plac regarding survival rate and collagen content. Treatment with the anti-inflammatory and antifibrotic drug, Tra, started four weeks after the induction of a large MI in the rat, did not attenuate or positively influence remodeling in chronic ischemic heart failure and survival. Further studies are required to explore the effects of Tra on cardiac myocytes post-MI in more detail. PMID:25371734

  3. Late onset oral treatment with tranilast following large myocardial infarction has no beneficial effects on cardiac remodeling and mortality in rats

    PubMed Central

    BETGE, STEFAN; KUNZ, CHRISTIAN; FIGULLA, HANS; JUNG, CHRISTIAN

    2014-01-01

    Tranilast (Tra) reduces intracardiac interstitial fibrosis in the animal models of hypertensive heart failure and diabetic cardiomyopathy by inhibiting cardiac fibroblasts. The present study examined whether Tra has long-term effects on the cardiac remodeling in the remote area of the left ventricle (LV) following myocardial infarction (MI) in the rat. Treatment with Tra (n=40; 150 mg/kg twice daily) or placebo (Plac, n=36) was started at day 28 after induction of a large MI or sham-operation (ShO, n=18) in female Lewis rats. Collagen content was determined using high-performance liquid chromatography. Large MI led to a significant hypertrophy of the two ventricles, a severe dilatation of the LV and a shift of the chamber stiffness variables in the pressure volume curves. The six-month survival rates were Tra, 62.5%; Plac, 75%; and ShO, 100%. No significant difference was identified between Tra and Plac regarding survival rate and collagen content. Treatment with the anti-inflammatory and antifibrotic drug, Tra, started four weeks after the induction of a large MI in the rat, did not attenuate or positively influence remodeling in chronic ischemic heart failure and survival. Further studies are required to explore the effects of Tra on cardiac myocytes post-MI in more detail. PMID:25371734

  4. Cardiac decompression after operation for congenital heart disease in infancy.

    PubMed

    Elami, A; Permut, L C; Laks, H; Drinkwater, D C; Sebastian, J L

    1994-11-01

    Between January 1987 and July 1992, 641 infants (less than 1 year of age) underwent cardiac surgical procedures through a median sternotomy incision at the UCLA Medical Center. In 36 (5.6%), to achieve cardiac decompression, the chest was left open after the operation, or was re-opened immediately postoperatively because of low cardiac output. The incidence of cardiac decompression was 31% (4/13) after the Norwood procedure and 24% (7/29) after truncus arteriosus repair. Opening of the chest reduced intrathoracic pressure and allowed complete expansion of the lungs. Delayed sternal closure was carried out in 27 patients at a mean of 5 days (range, 2 to 14 days) postoperatively. By the time of chest closure, left atrial pressure had decreased from a mean of 12 +/- 1.4 to 8.4 +/- 0.8 mm Hg (p < 0.004), and inotropic drug support with dopamine and dobutamine had also decreased significantly. Thirteen (36%) patients died of low cardiac output and multiorgan failure (4 of them after delayed chest closure) that was complicated by sepsis in 2. The incidence of sternal wound infection was relatively low at 5.6% (2/36); 1 patient died of generalized sepsis complicating multiorgan failure and the second case occurred in a patient who survived long term after sternectomy. With optimal ventilatory and inotropic drug support and meticulous wound care, delayed sternal closure may improve the survival of infants in low cardiac output after cardiac surgical procedures. PMID:7979665

  5. Three chamber negative ion source

    DOEpatents

    Leung, Ka-Ngo (Hercules, CA); Ehlers, Kenneth W. (Alamo, CA); Hiskes, John R. (Livermore, CA)

    1985-01-01

    A negative ion vessel is divided into an excitation chamber, a negative ionization chamber and an extraction chamber by two magnetic filters. Input means introduces neutral molecules into a first chamber where a first electron discharge means vibrationally excites the molecules which migrate to a second chamber. In the second chamber a second electron discharge means ionizes the molecules, producing negative ions which are extracted into or by a third chamber. A first magnetic filter prevents high energy electrons from entering the negative ionization chamber from the excitation chamber. A second magnetic filter prevents high energy electrons from entering the extraction chamber from the negative ionizing chamber. An extraction grid at the end of the negative ion vessel attracts negative ions into the third chamber and accelerates them. Another grid, located adjacent to the extraction grid, carries a small positive voltage in order to inhibit positive ions from migrating into the extraction chamber and contour the plasma potential. Additional electrons can be suppressed from the output flux using ExB forces provided by magnetic field means and the extractor grid electric potential.

  6. Cardiac function in patients with prior myocarditis

    SciTech Connect

    Das, S.K.; Brady, T.J.; Thrall, J.H.; Pitt, B.

    1980-07-01

    Gated cardiac blood-pool imaging under rest and exercise was used to assess left-ventricular functional reserve in six asymptomatic patients with prior myocarditis and six age matched control subjects. Coronary artery disease was excluded in three of the six patients by coronary arteriography. In the remaining three, coronary artery disease was thought unlikely on the basis of history and the presence, during exercise, of a normal ECG and normal Tl-201 myocardial image. Conventional indices of resting left-ventricular function - including cardiothoracic ratio, echocardiographic left-ventricular diameter, and percentage change in minor diameter - were normal in those with prior myocarditis. The mean resting left-ventricular ejection fraction was also normal by gated blood-pool imaging, and not significantly different from that for control patients: 0.58 +- 0.05 and 0.65 +- 0.02, respectively. Three patients with prior myocarditis had resting left-ventricular ejection fractions of less than 0.50. On exercise, the patients with prior myocarditis decreased their mean left-ventricular ejection fraction by an average of 8% compared with an increase of 15% in the control group (p < 0.01). This study suggests that asymptomatic patients with prior myocarditis have left-ventricular dysfunction that may not be clinically apparent, and suggests the need for further long-term follow-up.

  7. Electrocardiographic consequences of cardiac iron overload in thalassemia major

    PubMed Central

    Detterich, Jon; Noetzli, Leila; Dorey, Fred; Bar-Cohen, Yaniv; Harmatz, Paul; Coates, Thomas; Wood, John

    2011-01-01

    Background Iron cardiomyopathy is a leading cause of death in transfusion dependent thalassemia major (TM) patients and MRI (T2*) can recognize preclinical cardiac iron overload, but, is unavailable to many centers. Design and Methods We evaluated the ability of 12-lead electrocardiography to predict cardiac iron loading in TM. 12-lead electrocardiogram and cardiac T2* measurements were performed prospectively, with a detectable cardiac iron cutoff of T2*less than 20 ms. Patients with and without cardiac iron were compared using two-sample statistics and against population norms using age and gender-matched Z-scores. Results 45/78 patients had detectable cardiac iron. Patients having cardiac iron were older and more likely female but had comparable liver iron burdens and serum ferritin. Increased heart rate (HR) and prolonged corrected QT interval (QTc) were present, regardless of cardiac iron status. Repolarization abnormalities were the strongest predictors of cardiac iron, including QT/QTc prolongation, left shift of T-wave axis, and interpretation of ST/T-wave morphology. Recursive partitioning of the data for females using T-axis and HR and for males using QT, HR and T-axis produced algorithms with AUROC’s of 88.3 and 87.1 respectively. Conclusions Bradycardia and repolarization abnormalities on 12-lead electrocardiography were the most specific markers for cardiac iron in thalassemia major. Changes in these variables may be helpful to stratify cardiac risk when cardiac MRI is unavailable. However, diagnostic algorithms need to be vetted on larger and more diverse patient populations and longitudinal studies are necessary to determine reversibility of the observed abnormalities. PMID:22052662

  8. Cardiogenetics, Neurogenetics, and Pathogenetics of Left Ventricular Hypertrabeculation\\/Noncompaction

    Microsoft Academic Search

    Josef Finsterer

    2009-01-01

    Background  Left ventricular hypertrabeculation (LVHT), also known as noncompaction or spongy myocardium, is a cardiac abnormality of\\u000a unknown etiology and pathogenesis frequently associated with genetic cardiac and noncardiac disorders, particularly genetic\\u000a neuromuscular disease. This study aimed to review the current knowledge about the genetic or pathogenetic background of LVHT.\\u000a \\u000a \\u000a \\u000a Methods  A literature review of all human studies dealing with the association of

  9. Multiple Metastatic Intracranial Lesions Associated with Left Atrial Myxoma

    PubMed Central

    Kierdaszuk, Biruta; Gogol, Pawe?; Kolasa, Anna; Maj, Edyta; Zakrzewska-Pniewska, Beata; Go??biowski, Marek; Kami?ska, Anna M.

    2014-01-01

    Summary Background One of the most common cardiac tumors is myxoma. Despite its predominantly benign course, diverse cardiological, systemic as well as neurological complications have been reported. Case Report We are the first from Poland to present the case of a patient with multiple central nervous system metastases associated with the left atrial myxoma. Various diagnostic, neuroradiological and histopathological procedures were described. The patient underwent cardiac surgery. Conclusions Follow-up studies excluded the recurrence of the heart tumor and confirmed partial resolution of brain metastases. Nevertheless, subsequent neurological assessment was advised according to the literature data and possible late relapses mainly due to cerebral emboli. PMID:25152797

  10. Multiwire proportional chamber development

    NASA Technical Reports Server (NTRS)

    Doolittle, R. F.; Pollvogt, U.; Eskovitz, A. J.

    1973-01-01

    The development of large area multiwire proportional chambers, to be used as high resolution spatial detectors in cosmic ray experiments is described. A readout system was developed which uses a directly coupled, lumped element delay-line whose characteristics are independent of the MWPC design. A complete analysis of the delay-line and the readout electronic system shows that a spatial resolution of about 0.1 mm can be reached with the MWPC operating in the strictly proportional region. This was confirmed by measurements with a small MWPC and Fe-55 X-rays. A simplified analysis was carried out to estimate the theoretical limit of spatial resolution due to delta-rays, spread of the discharge along the anode wire, and inclined trajectories. To calculate the gas gain of MWPC's of different geometrical configurations a method was developed which is based on the knowledge of the first Townsend coefficient of the chamber gas.

  11. Crystals in magma chambers

    NASA Astrophysics Data System (ADS)

    Higgins, M.

    2011-12-01

    Differentiation processes in igneous systems are one way in which the diversity of igneous rocks is produced. Traditionally, magmatic diversity is considered as variations in the overall chemical composition, such as basalt and rhyolite, but I want to extend this definition to include textural diversity. Such textural variations can be manifested as differences in the amount of crystalline (and immiscible liquid) phases and in the origin and identity of such phases. One important differentiation process is crystal-liquid separation by floatation or decantation, which clearly necessitates crystals in the magma. Hence, it is important to determine if magmas in chambers (sensu lato) have crystals. The following discussion is framed in generalities - many exceptions occur. Diabase (dolerite) dykes are a common, widespread result of regional mafic magmatism. The rims of most diabase dykes have few or no phenocrysts and crystals in the cores are commonly thought to have crystallized in place. Hence, this major mafic magmatic source did not have crystals, although compositional diversity of these dykes is commonly explained by crystal-liquid separation. This can be resolved if crystallisation was on the walls on the magma chamber. Similarly, most flood basalts are low in crystals and separation of those that are present cannot always explain the observed compositional diversity. Crystal-rich flows do occur, for example the 'Giant Plagioclase Basalts' of the Deccan series, but the crystals are thought to form or accumulate in a crystal-rich zone beneath the roof of the chamber - the rest of the chamber probably has few crystals. Some magmas from Hawaii contain significant amounts of olivine crystals, but most of these are deformed and cannot have crystallised in the chamber. In this case the crystals are thought to grow as the magma passes through a decollement zone. They may have grown on the walls or been trapped by filters. Basaltic andesite ignimbrites generally have few crystals, in contrast to lavas from the same volcanoes. Hence, crystallisation must be a high-level process before eruption. Layering in mafic intrusions has many different origins, but some appears to be the result of crystal settling. If such mineralogical layering is present then so must crystals have been present in the magma. However, it is only necessary that crystals are present in local regions, such as along the floor, walls or roof. All this suggests that most mafic or intermediate magmas in chambers do not have substantial quantities of crystals, except at the peripheries. Felsic (sensu lato) rocks present a rather different story: Although there are many examples of low-crystallinity felsic tuffs and lavas, there are also large ignimbrites with high crystal contents, such as the Fish Canyon tuff. Indeed a 'typical' andesite or dacite is loaded with crystals, generally with long and complex histories. The widespread occurrence of megacrysts in felsic plutonic, and some volcanic, rocks also suggests that crystals are present in magma chambers and can exist for extended periods of time. This would suggest that it is possible, and indeed common, for a felsic magma chamber to have crystals throughout. The difficulty here for differentiation is the high viscosity of such magmas.

  12. Hypothyroidism and Its Rapid Correction Alter Cardiac Remodeling

    PubMed Central

    Itani, Tarek; Moubarak, Majed; Aftimos, Georges; Farès, Nassim

    2014-01-01

    The cardiovascular effects of mild and overt thyroid disease include a vast array of pathological changes. As well, thyroid replacement therapy has been suggested for preserving cardiac function. However, the influence of thyroid hormones on cardiac remodeling has not been thoroughly investigated at the molecular and cellular levels. The purpose of this paper is to study the effect of hypothyroidism and thyroid replacement therapy on cardiac alterations. Thirty Wistar rats were divided into 2 groups: a control (n?=?10) group and a group treated with 6-propyl-2-thiouracil (PTU) (n?=?20) to induce hypothyroidism. Ten of the 20 rats in the PTU group were then treated with L-thyroxine to quickly re-establish euthyroidism. The serum levels of inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor alpha (TNF-?), interleukin 6 (IL6) and pro-fibrotic transforming growth factor beta 1 (TGF-?1), were significantly increased in hypothyroid rats; elevations in cardiac stress markers, brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) were also noted. The expressions of cardiac remodeling genes were induced in hypothyroid rats in parallel with the development of fibrosis, and a decline in cardiac function with chamber dilation was measured by echocardiography. Rapidly reversing the hypothyroidism and restoring the euthyroid state improved cardiac function with a decrease in the levels of cardiac remodeling markers. However, this change further increased the levels of inflammatory and fibrotic markers in the plasma and heart and led to myocardial cellular infiltration. In conclusion, we showed that hypothyroidism is related to cardiac function decline, fibrosis and inflammation; most importantly, the rapid correction of hypothyroidism led to cardiac injuries. Our results might offer new insights for the management of hypothyroidism-induced heart disease. PMID:25333636

  13. Right or Left?

    NSDL National Science Digital Library

    This activity challenges students to visualize compound transformations of hexahedral dice to determine their right- or left-handedness. Ideas for implementation and support are included along with printable sheets of both types of dice.

  14. Left heart catheterization

    MedlinePLUS

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye will be injected into your ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  15. Cardiac fluid dynamics anticipates heart adaptation.

    PubMed

    Pedrizzetti, Gianni; Martiniello, Alfonso R; Bianchi, Valter; D'Onofrio, Antonio; Caso, Pio; Tonti, Giovanni

    2015-01-21

    Hemodynamic forces represent an epigenetic factor during heart development and are supposed to influence the pathology of the grown heart. Cardiac blood motion is characterized by a vortical dynamics, and it is common belief that the cardiac vortex has a role in disease progressions or regression. Here we provide a preliminary demonstration about the relevance of maladaptive intra-cardiac vortex dynamics in the geometrical adaptation of the dysfunctional heart. We employed an in vivo model of patients who present a stable normal heart function in virtue of the cardiac resynchronization therapy (CRT, bi-ventricular pace-maker) and who are expected to develop left ventricle remodeling if pace-maker was switched off. Intra-ventricular fluid dynamics is analyzed by echocardiography (Echo-PIV). Under normal conditions, the flow presents a longitudinal alignment of the intraventricular hemodynamic forces. When pacing is temporarily switched off, flow forces develop a misalignment hammering onto lateral walls, despite no other electro-mechanical change is noticed. Hemodynamic forces result to be the first event that evokes a physiological activity anticipating cardiac changes and could help in the prediction of longer term heart adaptations. PMID:25529139

  16. Calcitriol Regresses Cardiac Hypertrophy and QT Dispersion in Secondary Hyperparathyroidism on Hemodialysis

    Microsoft Academic Search

    Hyung Wook Kim; Cheol Whee Park; Young Shin Shin; Young Soo Kim; Seok Jun Shin; Yong-Soo Kim; Euy Jin Choi; Yoon Sik Chang; Byung Kee Bang

    2006-01-01

    Background: Sudden cardiac death is common in patients on hemodialysis (HD), and its rate is as high as 25% of all cardiac deaths associated with left ventricular hypertrophy (LVH) and secondary hyperparathyroidism. A prolonged QT interval on standard electrocardiography is related to an increase in sudden death in various patient groups. It is also well known that LVH has been

  17. MSCT labelling for pre-operative planning in cardiac resynchronization therapy

    Microsoft Academic Search

    Kristell Rioual; Edurne Unanua; Soizic Laguitton; Mireille Garreau; Dominique Boulmier; Pascal Haigron; Christophe Leclercq; Jean-Louis Coatrieux

    2005-01-01

    The objective of this paper is twofold: (i) to show how multislice computed tomography (MSCT) data sets bring the information required for cardiac resynchronisation therapy (CRT) planning; (ii) to demonstrate the feasibility of 3D navigation into the veins where left ventricular leads have to be placed. The former has been achieved by exploring and labelling the cardiac structures of concern,

  18. Digital optical spark chambers

    SciTech Connect

    Evenson, P.; Tuska, E.

    1989-02-01

    The authors have constructed and tested a prototype digital readout system for optical spark chambers using a linear, solid state (CCD) detector array. Position resolution of 0.013 mm (sigma) over a 25 centimeter field of view has been demonstrated. This technique should permit the construction of economical, light weight and low power trajectory hodoscopes for use in cosmic ray instrumentation on balloons and in spacecraft.

  19. Evaluation and management of the cardiac amyloidosis.

    PubMed

    Selvanayagam, Joseph B; Hawkins, Philip N; Paul, Biju; Myerson, Saul G; Neubauer, Stefan

    2007-11-27

    Cardiac amyloidosis describes clinically significant involvement of the heart by amyloid deposition, which may or may not be associated with involvement of other organs. The purpose of this review is to summarize the current state of evidence for the effective evaluation and management of cardiac amyloidosis. Acquired systemic amyloidosis occurs in more than 10 per million person-years in the U.S. population. Although no single noninvasive test or abnormality is pathognomonic of cardiac amyloid, case-control studies indicate that echocardiographic evidence of left ventricular wall thickening, biatrial enlargement, and increased echogenicity in conjunction with reduced electrocardiographic voltages is strongly suggestive of cardiac amyloidosis. Furthermore, newer echocardiographic techniques such as strain and strain rate imaging can demonstrate impairment in longitudinal function before ejection fraction becomes abnormal. Recent observational studies also suggest that cardiovascular magnetic resonance imaging yields characteristic findings in amyloidosis, offering promise for the early detection of cardiac involvement, and the presence of detectable cardiac troponin and elevated B-type natriuretic peptide in serum of affected patients portends an adverse prognosis. Management strategies for cardiac amyloid are largely based on nonrandomized single-center studies. One of the few published randomized studies shows the superiority of oral prednisolone and melphalan compared with colchicine in systemic AL amyloidosis. Intermediate-dose infusional chemotherapy regimes (such as vincristine, adriamycin, and dexamethasone) and high-dose chemotherapy with peripheral stem cell rescue have been used widely, but treatment-related mortality remains substantial with chemotherapy. Recent studies also indicate promising strategies to stabilize the native structures of amyloidogenic proteins; inhibit fibril formation; and disrupt established deposits using antibodies, synthetic peptides, and small-molecule drugs. PMID:18036445

  20. Cardiac rehabilitation and artificial heart devices.

    PubMed

    Ueno, Atsuko; Tomizawa, Yasuko

    2009-01-01

    Recently, cardiac rehabilitation has gained popularity in Japan because beneficial effects on patients' prognosis have been reported. Another reason is that cardiac rehabilitation has been covered by health insurance since 1988 in Japan. Currently, cardiac rehabilitation is covered for the diseases of angina pectoris, acute myocardial infarction, chronic heart failure (CHF), peripheral arterial disease, and diseases of the aorta and after open-heart surgery. Left ventricular assist devices (LVADs) are sometimes used in patients with progressive CHF symptoms to provide circulatory support, because in most of these patients heart failure does not improve with application of medical therapy, intra-aortic balloon pumping, or a percutaneous cardiopulmonary system. Modern VAD control systems are compact, allowing patients to carry them around without difficulty. Since patient management at the outpatient clinic has become possible, patients are able to expand the scope of their activities. Early active rehabilitation in patients implanted with a LVAD improves their condition, favorably impacts the clinical course while they await heart transplantation, and also improves posttransplant recovery. Exercise therapy is one of the important components in comprehensive cardiac rehabilitation. Exercise therapy is important to improve the quality of life of patients with LVADs. Appropriate exercise therapy is effective for patients with various cardiac conditions who undergo diverse treatments and is practiced actively by many patients. In order to facilitate cardiac rehabilitation safely and effectively for patients with serious conditions, education for health care professionals is essential. In this review, we describe the concept of rehabilitation followed by cardiac rehabilitation for patients with heart failure, patients after open-heart surgery, and patients with implanted LVADs. PMID:19536625

  1. Determination of cardiac size following space missions of different durations - The second manned Skylab mission

    NASA Technical Reports Server (NTRS)

    Nicogossian, A.; Hoffler, G. W.; Johnson, R. L.; Gowen, R. J.

    1976-01-01

    A simple method to estimate cardiac size from single frontal plane chest roentgenograms has been described. Pre- and postflight chest X-rays from Apollo 17, and Skylab 2 and 3 have been analyzed for changes in the cardiac silhouette size. The data obtained from the computed cardiothoracic areal ratios compared well with the clinical cardiothoracic diametral ratios (r = .86). Though an overall postflight decrease in cardiac size is evident, the mean difference was not statistically significant (n = 8). The individual decreases in the cardiac silhouette size postflight are thought to be due to decrements in intracardiac chamber volumes rather than in myocardial muscle mass.

  2. Diabetes influences cardiac extracellular matrix remodelling after myocardial infarction and subsequent development of cardiac dysfunction

    PubMed Central

    Eguchi, Megumi; Xu, Guoxiong; Li, Ren-Ke; Sweeney, Gary

    2012-01-01

    This study was conducted to examine the influence of acute streptozotocin-induced diabetes on cardiac remodelling and function in mice subjected to myocardial infarction (MI) by coronary artery ligation. Echocardiography analysis indicated that diabetes induced deleterious cardiac functional changes as demonstrated by the negative differences of ejection fraction, fractional shortening, stroke volume, cardiac output and left ventricular volume 24 hrs after MI. Temporal analysis for up to 2 weeks after MI showed higher mortality in diabetic animals because of cardiac wall rupture. To examine extracellular matrix remodelling, we used fluorescent molecular tomography to conduct temporal studies and observed that total matrix metalloproteinase (MMP) activity in hearts was higher in diabetic animals at 7 and 14 days after MI, which correlated well with the degree of collagen deposition in the infarct area visualized by scanning electron microscopy. Gene arrays indicated temporal changes in expression of distinct MMP isoforms after 1 or 2 weeks after MI, particularly in diabetic mice. Temporal changes in cardiac performance were observed, with a trend of exaggerated dysfunction in diabetic mice up to 14 days after MI. Decreased radial and longitudinal systolic and diastolic strain rates were observed over 14 days after MI, and there was a trend towards altered strain rates in diabetic mouse hearts with dyssynchronous wall motion clearly evident. This correlated with increased collagen deposition in remote areas of these infarcted hearts indicated by Masson's trichrome staining. In summary, temporal changes in extracellular matrix remodelling correlated with exaggerated cardiac dysfunction in diabetic mice after MI. PMID:22862852

  3. Echocardiographic versus cardiac catheterization diagnosis of infants with congenital heart disease requiring cardiac surgery.

    PubMed

    Krabill, K A; Ring, W S; Foker, J E; Braunlin, E A; Einzig, S; Berry, J M; Bass, J L

    1987-08-01

    The success of noninvasive preoperative evaluation of infants with congenital heart disease using cardiac ultrasound depends not only on diagnostic accuracy, but also on risk of morbidity and mortality as compared with infants who undergo cardiac catheterization. Fifty-six infants (age 10 weeks or younger) with coarctation of the aorta (n = 16), coarctation with ventricular septal defect (n = 12), valvar aortic stenosis (n = 10) or total anomalous pulmonary venous connection (n = 18) were examined. Thirty-one underwent noninvasive preoperative assessment and 25 underwent evaluation including cardiac catheterization. Age, level and duration of support, pH, renal function, mortality, complications of cardiac catheterization and errors of diagnosis were compared. Significant differences between the 2 groups were more frequent preoperative use of prostaglandin E1 and shorter hospital stay in the noninvasively evaluated coarctation group. Of the infants with coarctation and ventricular septal defect, 1 who had cardiac catheterization required renal transplantation and 1 evaluated noninvasively required surgery at age 3 months for mitral stenosis not discovered on preoperative evaluation. One noninvasively evaluated infant with total anomalous pulmonary venous connection had a stenotic communication between the pulmonary venous confluence and the left atrium not detected by ultrasound. Surgery was successful in the latter 2 infants. Noninvasive preoperative diagnosis of some infants with congenital heart disease can be performed without increasing the risk of operative morbidity and mortality. Eliminating cardiac catheterization reduces hospital costs, decreases total numbers of catheterizations performed and influences the structure of training programs. PMID:3618495

  4. Effect of prolonged exercise in a hypoxic environment on cardiac function and cardiac troponin T

    PubMed Central

    Shave, R; Dawson, E; Whyte, G; George, K; Gaze, D; Collinson, P

    2004-01-01

    Objective: To investigate if exercise induced cardiac fatigue and or cardiac damage occurs after prolonged exercise in a hypoxic environment. Methods: Eight trained male triathletes volunteered for the study. Each completed two 50 mile cycle trials, randomly assigned from normobaric normoxia and normobaric hypoxia (15% FIO2). Echocardiographic assessment and whole blood collection was completed before, immediately after, and 24 hours after exercise. Left ventricular systolic and diastolic functional variables were calculated, and serum was analysed for cardiac troponin T. Results were analysed using a two way repeated measures analysis of variance, with ? set at 0.05. Results: No significant differences were observed in either systolic or diastolic function across time or between trials. Cardiac troponin T was detected in one subject immediately after exercise in the normobaric hypoxic trial. Conclusions: A 50 mile cycle trial in either normobaric normoxia or normobaric hypoxia does not induce exercise induced cardiac fatigue. Some people, however, may exhibit minimal cardiac damage after exercise in normobaric hypoxia. The clinical significance of this is yet to be elucidated. PMID:14751955

  5. Experimental evaluation of anechoic chambers

    Microsoft Academic Search

    W. Kummer; A. Villeneuve

    1965-01-01

    Antenna gain and radiation patterns, as well as radar cross sections of objects are measured in anechoic chambers. The chambers are used for convenience and to eliminate, as far as practical, sources of unwanted reflections. It would be useful if anechoic chambers could be categorized by a figure of merit which would predict their performance when antenna measurements are made.

  6. Vertical two chamber reaction furnace

    DOEpatents

    Blaugher, Richard D. (Evergreen, CO)

    1999-03-16

    A vertical two chamber reaction furnace. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium-copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700.degree. and 800.degree. C.) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800.degree. to 950.degree. C. to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product.

  7. Vertical two chamber reaction furnace

    DOEpatents

    Blaugher, R.D.

    1999-03-16

    A vertical two chamber reaction furnace is disclosed. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700 and 800 C) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800 to 950 C to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product. 2 figs.

  8. Vibrating-chamber levitation systems

    NASA Technical Reports Server (NTRS)

    Barmatz, M. B.; Granett, D.; Lee, M. C. (inventors)

    1985-01-01

    Systems are described for the acoustic levitation of objects, which enable the use of a sealed rigid chamber to avoid contamination of the levitated object. The apparatus includes a housing forming a substantially closed chamber, and means for vibrating the entire housing at a frequency that produces an acoustic standing wave pattern within the chamber.

  9. The Clinical Benefits of Adding a Third Dimension to Assess the Left Ventricle with Echocardiography

    PubMed Central

    Badano, Luigi P.

    2014-01-01

    Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management. PMID:24959374

  10. Sudden cardiac death in end-stage renal disease patients: a 5-year prospective analysis.

    PubMed

    Wang, Angela Yee-Moon; Lam, Christopher Wai-Kei; Chan, Iris Hiu-Shuen; Wang, Mei; Lui, Siu-Fai; Sanderson, John E

    2010-08-01

    End-stage renal disease patients experience a high incidence of sudden cardiac death. We performed a 5-year prospective study in 230 end-stage renal disease patients, aiming to determine the role of echocardiography and the additional value of serum biomarkers in predicting sudden cardiac death. During follow-up, 24% of all deaths were attributed to sudden cardiac death. In the multivariable Cox regression analysis considering clinical, biochemical, dialysis, and echocardiographic parameters, left ventricular systolic dysfunction emerged as the most significant predictor of sudden cardiac death, followed by a high systolic and a low diastolic blood pressure. An ejection fraction cutoff cardiac death. In biomarker-based multivariable Cox regression analysis, N-terminal probrain natriuretic peptide displays an independent association with sudden cardiac death and is more significantly associated with sudden cardiac death than cardiac troponin T. In the combined echocardiography and biomarker-based multivariable Cox regression model, N-terminal probrain natriuretic peptide loses significance to left ventricular ejection fraction, whereas cardiac troponin T retains a significant association with sudden cardiac death independent of echocardiographic parameters. In conclusion, systolic dysfunction is the most significant predictor of sudden cardiac death followed by a high systolic and a low diastolic blood pressure. Our data suggest additional value in measuring cardiac troponin T for sudden cardiac death risk stratification. N-terminal probrain natriuretic peptide may be used in place of echocardiography to identify patients at risk of sudden cardiac death but had no added value over echocardiography in predicting sudden cardiac death. PMID:20606110

  11. The roles of Groucho\\/Tle in left–right asymmetry and Kupffer’s vesicle organogenesis

    Microsoft Academic Search

    Baubak Bajoghli; Narges Aghaallaei; Daniele Soroldoni; Thomas Czerny

    2007-01-01

    The heart is the first organ to form and function in the vertebrate embryo. Furthermore, differences between the left and right sides of the embryo become first detectable during cardiac development. We observed strong cardiac laterality phenotypes in medaka embryos by manipulating Groucho protein activity. The phenotypes produced by misexpressing Tle4 and the dominant-negative Aes reveal a general effect of

  12. Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease

    Microsoft Academic Search

    F Loperfido; F Pennestri; A Digaetano; E Scabbia; P Santarelli; R Mongiardo; G Schiavoni; E Coppola; U Manzoli

    1983-01-01

    Left atrial dimensions were measured using cross sectional echocardiography in 37 patients with mitral valve disease and 30 normal subjects of similar ages. The anteroposterior (AP), superior-inferior (SI), and medial-lateral (ML) left atrial dimensions were determined at the end of ventricular systole using parasternal long and short axis and apical four chamber views (for SIa and MLa). To assess the

  13. Normal mitral annulus dynamics and its relationships with left ventricular and left atrial function.

    PubMed

    Mihaila, Sorina; Muraru, Denisa; Miglioranza, Marcelo Haertel; Piasentini, Eleonora; Peluso, Diletta; Cucchini, Umberto; Iliceto, Sabino; Vinereanu, Dragos; Badano, Luigi P

    2015-02-01

    Mitral annulus (MA) geometry and dynamics are crucial for preserving normal mitral valve (MV) function. Static reference values for MA parameters have been reported, but the normal MA dynamics during the entire cardiac cycle remains controversial. MV full-volume datasets were obtained by three-dimensional transthoracic echocardiography from 50 healthy volunteers (18-74 years; 31 men) to assess MA changes in size and shape during entire cardiac cycle. Using simultaneous multiplanar review, projected MA area (MAA) and circumference (MAC), antero-posterior (AP) and anterolateral-posteromedial (ALPM) diameters, and sphericity index (SphI) were obtained at: mitral valve closure (MVC), mid- and end-systole (ES), early- (EDF) and late-diastolic filling, and end-diastole. MAA and AP diameter were the most "active" parameters, changing in all reference frames (p < 0.001). MAA and AP diameter started to contract before MVC (during the left atrial contraction), reaching their minimum at MVC. Maximum MAA occurred at ES, while maximum AP diameter and SphI occurred at EDF. MAA fractional shortening was 35 ± 10 %. AP diameter change was 25 ± 10 %. MAC, ALPM and SphI showed similar patterns during left ventricular (LV) systole, and remained unchanged during diastole. Fractional change was 35 ± 10 % for MAC, and 13 ± 8 % for ALPM diameter. Our study provides the normal dynamics of the MA during the entire cardiac cycle. It reveals "pre-systolic" contraction of the MA, related to left atrial (LA) contraction, and minimal MAA during early LV systole. Therefore, the normal MA dynamics relates to a "physiologic LA-LV coupling", and a complete MA contraction requires both and properly timed LA and LV systole. PMID:25319092

  14. Left coronary arterial blood flow: Noninvasive detection by Doppler US

    SciTech Connect

    Gramiak, R.; Holen, J.; Moss, A.J.; Gutierrez, O.H.; Picone, A.L.; Roe, S.A.

    1986-06-01

    Continuous wave (CW) and pulsed Doppler ultrasound studies with spectral analysis were used to detect the left coronary arterial blood flow in patients who were undergoing routine echocardiography. The pulmonary artery is a stable ultrasonic landmark from which detection of the blood flow can be effected. The left coronary artery can be distinguished by its blood flow toward the cardiac apex and by specific, functional flow features. Flow patterns vary among the left main, circumflex, and anterior descending arteries; patterns also vary with respiration cycles. In the present study, coronary arterial blood flow was detected in 58 of 70 patients (83%). Findings were validated by selectively injecting an agitated saline contrast medium into the left coronary artery and, in another study, by comparing human Doppler phasic flow waveforms with electromagnetic flowmeter recordings obtained in dogs.

  15. Review of wire chamber aging

    SciTech Connect

    Va'Vra, J.

    1986-02-01

    This paper makes an overview of the wire chamber aging problems as a function of various chamber design parameters. It emphasizes the chemistry point of view and many examples are drawn from the plasma chemistry field as a guidance for a possible effort in the wire chamber field. The paper emphasizes the necessity of variable tuning, the importance of purity of the wire chamber environment, as well as it provides a practical list of presently known recommendations. In addition, several models of the wire chamber aging are qualitatively discussed. The paper is based on a summary talk given at the Wire Chamber Aging Workshop held at LBL, Berkeley on January 16-17, 1986. Presented also at Wire Chamber Conference, Vienna, February 25-28, 1986. 74 refs., 18 figs., 11 tabs.

  16. [Role of cardiac computed tomography in cardiac surgery].

    PubMed

    Shimahara, Yusuke; Kobayashi, Junjiro; Kanzaki, Suzu; Higashi, Masahiro

    2014-07-01

    In the field of cardiovascular surgery, cardiac computed tomography (CT) has served an important role in association with the improvement of the spatial and temporal resolution. Because CT angiography (CTA) provides more available information than plain CT, CTA has been increasingly used to access the coronary arteries and graft patency after coronary artery bypass grafting (CABG). Recently, minimally invasive cardiac surgeries, including CABG with left mini-thoracotomy and mitral valve surgery with right mini-thoracotomy, are revived, which requires preoperative CTA to make a strategy of incision placement on the basis of anatomical relationship between the target structure of the heart and the thorax. In Japan, transcatheter aortic valve implantation (TAVI) was approved in the late 2013, and is expected to be widely performed in the future. CTA is extremely useful for TAVI patients to determine the choice of the valve size and the surgical approach. CT provides many other valuable findings to us, but if we cannot fully leverage it in the daily cardiovascular surgery, its value is decreased. We have to acquire enough skill to maximize the performance of CT in the practical clinical setting. PMID:25138927

  17. Gene therapy in cardiac arrhythmias.

    PubMed

    Praveen, S V; Francis, Johnson; Venugopal, K

    2006-01-01

    Gene therapy has progressed from a dream to a bedside reality in quite a few human diseases. From its first application in adenosine deaminase deficiency, through the years, its application has evolved to vascular angiogenesis and cardiac arrhythmias. Gene based biological pacemakers using viral vectors or mesenchymal cells tested in animal models hold much promise. Induction of pacemaker activity within the left bundle branch can provide stable heart rates. Genetic modification of the AV node mimicking beta blockade can be therapeutic in the management of atrial fibrillation. G protein overexpression to modify the AV node also is experimental. Modification and expression of potassium channel genes altering the delayed rectifier potassium currents may permit better management of congenital long QT syndromes. Arrhythmias in a failing heart are due to abnormal calcium cycling. Potential targets for genetic modulation include the sarcoplasmic reticulum calcium pump, calsequestrin and sodium calcium exchanger. Lastly the ethical concerns need to be addressed. PMID:16943902

  18. Cardiac Magnetic Resonance Imaging

    Microsoft Academic Search

    Michael Jerosch-Herold; Ravi Teja Seethamraju; Carsten Rickers

    Magnetic resonance imaging (MRI) has proven to be extremely versatile and useful for studying cardiac anatomy and function,\\u000a both for providing a deeper understanding of cardiac physiology and as a means to diagnose cardiac diseases. The capabilities\\u000a of MRI as a tomographic imaging modality to capture, with high spatial resolution, the anatomy of 3D structures was already\\u000a well appreciated before

  19. A case of left atrial myxoma with unusual tumor vascularity.

    PubMed

    Shabestari, Mahmoud Mohammadzadeh; Fazlinezhad, Afsoon; Moravvej, Zahra; Tashnizi, Mohammad Abbasi; Azari, Ali; Bigdelu, Leila

    2013-11-26

    A 69-year-old woman presented with a 2-week history of chest pain and mitral and aortic valve replacement 15 and 5 years earlier. Transthoracic echocardiography revealed a well-seated monoleaflet mitral valve and a bileaflet aortic valve with normal function. Cardiac catheterization showed 3-vessel coronary artery disease and an abnormal cluster of new vessels derived from the left atrial circumflex and posterior ventricle branches. Two- and 3-dimensional transesophageal echocardiography identified a semi-mobile oval left atrial mass with multiple internal cystic spaces, attached to the fossa ovalis region in the interatrial septum. The mass was resected. The pathological diagnosis was atrial myxoma. PMID:24887916

  20. Large left ventricular metastasis in patient with liposarcoma.

    PubMed

    Dendramis, Gregory; Di Lisi, Daniela; Paleologo, Claudia; Novo, Giuseppina; Novo, Salvatore

    2014-07-28

    Metastases to the heart and pericardium are rare. We present a 44-year-old male with pleural dedifferentiated liposarcoma and multiple metastases, with no previous cardiological history and/or cardiac symptoms. A transthoracic echocardiogram during the advanced stage of disease showed a lobulated, large and mobile mass, with homogeneous echogenicity, attached to the basal posterior wall of the left ventricle via a broad base and with intracavitary growth. This mass extends to inferolateral and inferoseptal wall of the left ventricle. PMID:25072804

  1. 18F-FLT PET Imaging in a Patient With Sarcoidosis With Cardiac Involvement.

    PubMed

    Norikane, Takashi; Yamamoto, Yuka; Maeda, Yukito; Noma, Takahisa; Nishiyama, Yoshihiro

    2015-05-01

    FDG PET has been proposed to play a role in the diagnosis and therapy monitoring of sarcoidosis including cardiac involvement. However, assessing inflammatory lesions in cardiac sarcoidosis using FDG can be challenging because the FDG accumulates in normal myocardium. We report a case of sarcoidosis with cardiac involvement that underwent 3'-deoxy-3'-F-fluorothymidine (FLT) PET. FLT PET images demonstrated increased uptake in the lymph nodes and left ventricle. After immunosuppressive therapy, a follow-up PET scan showed disappearance of FLT uptake in the lymph nodes and left ventricle. PMID:25546198

  2. Cathepsin K knockout alleviates aging-induced cardiac dysfunction.

    PubMed

    Hua, Yinan; Robinson, Timothy J; Cao, Yongtao; Shi, Guo-Ping; Ren, Jun; Nair, Sreejayan

    2015-06-01

    Aging is a major risk factor for cardiovascular disease. It has previously been shown that protein levels of cathepsin K, a lysosomal cysteine protease, are elevated in the failing heart and that genetic ablation of cathepsin K protects against pressure overload-induced cardiac hypertrophy and contractile dysfunction. Here we test the hypothesis that cathepsin K knockout alleviates age-dependent decline in cardiac function. Cardiac geometry, contractile function, intracellular Ca(2+) properties, and cardiomyocyte apoptosis were evaluated using echocardiography, fura-2 technique, immunohistochemistry, Western blot and TUNEL staining, respectively. Aged (24-month-old) mice exhibited significant cardiac remodeling (enlarged chamber size, wall thickness, myocyte cross-sectional area, and fibrosis), decreased cardiac contractility, prolonged relengthening along with compromised intracellular Ca(2+) release compared to young (6-month-old) mice, which were attenuated in the cathepsin K knockout mice. Cellular markers of senescence, including cardiac lipofuscin, p21 and p16, were lower in the aged-cathepsin K knockout mice compared to their wild-type counterpart. Mechanistically, cathepsin K knockout mice attenuated an age-induced increase in cardiomyocyte apoptosis and nuclear translocation of mitochondrial apoptosis-inducing factor (AIF). In cultured H9c2 cells, doxorubicin stimulated premature senescence and apoptosis. Silencing of cathepsin K blocked the doxorubicin-induced translocation of AIF from the mitochondria to the nuclei. Collectively, these results suggest that cathepsin K knockout attenuates age-related decline in cardiac function via suppressing caspase-dependent and caspase-independent apoptosis. PMID:25692548

  3. Radionuclide analysis of right and left ventricular response to exercise in patients with atrial and ventricular septal defects

    SciTech Connect

    Peter, C.A.; Bowyer, K.; Jones, R.H.

    1983-03-01

    In patients with ventricular or atrial septal defect, the ventricle which is chronically volume overloaded might not appropriately respond to increased demand for an augmentation in output and thereby might limit total cardiac function. In this study we simultaneously measured right and left ventricular response to exercise in 10 normal individuals, 10 patients with ventricular septal defect (VSD), and 10 patients with atrial septal defect (ASD). The normal subjects increased both right and left ventricular ejection fraction, end-diastolic volume, and stroke volume to achieve a higher cardiac output during exercise. Patients with VSD failed to increase right ventricular ejection fraction, but increased right ventricular end-diastolic volume and stroke volume. Left ventricular end-diastolic volume did not increase in these patients but ejection fraction, stroke volume, and forward left ventricular output achieved during exercise were comparable to the response observed in healthy subjects. In the patients with ASD, no rest-to-exercise change occurred in either right ventricular ejection fraction, end-diastolic volume, or stroke volume. In addition, left ventricular end-diastolic volume failed to increase, and despite an increase in ejection fraction, left ventricular stroke volume remained unchanged from rest to exercise. Therefore, cardiac output was augmented only by the heart rate increase in these patients. Right ventricular function appeared to be the major determinant of total cardiac output during exercise in patients with cardiac septal defects and left-to-right shunt.

  4. Cardiac stem cell niches.

    PubMed

    Leri, Annarosa; Rota, Marcello; Hosoda, Toru; Goichberg, Polina; Anversa, Piero

    2014-11-01

    The critical role that stem cell niches have in cardiac homeostasis and myocardial repair following injury is the focus of this review. Cardiac niches represent specialized microdomains where the quiescent and activated state of resident stem cells is regulated. Alterations in niche function with aging and cardiac diseases result in abnormal sites of cardiomyogenesis and inadequate myocyte formation. The relevance of Notch1 signaling, gap-junction formation, HIF-1? and metabolic state in the regulation of stem cell growth and differentiation within the cardiac niches are discussed. PMID:25267073

  5. [The best of cardiac pacing in 2005].

    PubMed

    Chauvin, M

    2006-01-01

    In 2005, the main subject of interest in the field of pacing was cardiac resynchronisation. The results of CARE-HF (Cardiac Resynchronisation on Morbidity and Mortality in Heart Failure), a large multicentre trial, were published. The investigators set out to establish whether resynchronisation pacing had a favourable effect on morbidity and mortality in patients with advanced cardiac failure and desynchronised compared with an identical population treated medically. The results showed that resynchronisation decreased the interventricular desynchronisation, decreased mitral regurgitation and, above all, improved symptoms and quality of life with a reduction in the incidence of complications and the risk of death. This publication is too recent for evaluation of the eventual repercussions of these results on the implantation of resynchronising pacemakers in France. The indication recommended by the scientific societies is still based on criteria which do not take echocardiographic data into account. However, the recommendations will probably change in the near future when the conclusions of trials currently under way, are published. From the technical point of view, the advances in cardiac pacing were mainly the new algorithms which avoid inappropriate ventricular stimulation of dual chamber pacemakers. It is well known that patients implanted with dual chamber pacemakers may, despite optimal adjustment of pacing parameters, have ineffective ventricular stimulation as the impulse falls in the phase of spontaneous ventricular depolarisation or effective but absolutely valueless. Several manufactures now propose pacemakers with algorithms which "search" for ventriculogrammes in order to avoid these situations of inadequate stimulation. Their efficacy has been demonstrated. Finally, in 2005, the diffusion of defibrillators equipped with a resynchronisation function has been confirmed. The conclusions of the COMPANION trial have been influential in promoting this usage although the results are mainly observed abroad. PMID:16479968

  6. Spatial Repolarization Heterogeneity Detected by Magnetocardiography Correlates with Cardiac Iron Overload and Adverse Cardiac Events in Beta-Thalassemia Major

    PubMed Central

    Chen, Chun-An; Lu, Meng-Yao; Peng, Shinn-Forng; Lin, Kai-Hsin; Chang, Hsiu-Hao; Yang, Yung-Li; Jou, Shiann-Tarng; Lin, Dong-Tsamn; Liu, Yen-Bin; Horng, Herng-Er; Yang, Hong-Chang; Wang, Jou-Kou; Wu, Mei-Hwan; Wu, Chau-Chung

    2014-01-01

    Background Patients with transfusion-dependent beta-thalassemia major (TM) are at risk for myocardial iron overload and cardiac complications. Spatial repolarization heterogeneity is known to be elevated in patients with certain cardiac diseases, but little is known in TM patients. The purpose of this study was to evaluate spatial repolarization heterogeneity in patients with TM, and to investigate the relationships between spatial repolarization heterogeneity, cardiac iron load, and adverse cardiac events. Methods and Results Fifty patients with TM and 55 control subjects received 64-channel magnetocardiography (MCG) to determine spatial repolarization heterogeneity, which was evaluated by a smoothness index of QTc (SI-QTc), a standard deviation of QTc (SD-QTc), and a QTc dispersion. Left ventricular function and myocardial T2* values were assessed by cardiac magnetic resonance. Patients with TM had significantly greater SI-QTc, SD-QTc, and QTc dispersion compared to the control subjects (all p values<0.001). Spatial repolarization heterogeneity was even more pronounced in patients with significant iron overload (T2*<20 ms, n?=?20) compared to those with normal T2* (all p values<0.001). Loge cardiac T2* correlated with SI-QTc (r?=??0.609, p<0.001), SD-QTc (r?=??0.572, p<0.001), and QTc dispersion (r?=??0.622, p<0.001), while all these indices had no relationship with measurements of the left ventricular geometry or function. At the time of study, 10 patients had either heart failure or arrhythmia. All 3 indices of repolarization heterogeneity were related to the presence of adverse cardiac events, with areas under the receiver operating characteristic curves (ranged between 0.79 and 0.86), similar to that of cardiac T2*. Conclusions Multichannel MCG demonstrated that patients with TM had increased spatial repolarization heterogeneity, which is related to myocardial iron load and adverse cardiac events. PMID:24475137

  7. Early identification of risk factors for sudden cardiac death

    Microsoft Academic Search

    Sumeet S. Chugh

    2010-01-01

    Sudden cardiac death (SCD) is a global health issue. The unexpected nature of this devastating condition compounds the urgency of discovering methods for early detection of risk, which will lead to more effective prevention. However, the complex and dynamic nature of SCD continues to present a considerable challenge for the early identification of risk factors. Measurement of the left ventricular

  8. Prevalence and upper limit of cardiac hypertrophy in professional cyclists

    Microsoft Academic Search

    J. J. Rodriguez Reguero; G. Iglesias Cubero; J. de la Iglesia López; N. Terrados; V. Gonzalez; R. Cortina; A. Cortina

    1995-01-01

    The term athlete's heart refers to an increased left ventricular mass. Few studies have assessed the prevalence and normal upper limit of cardiac hypertrophy in highly trained cyclists and this was the aim of this study. A group of 40 professional road cyclists [mean age 26 (SD 3) years] who had participated in European competitions for 3–10 years, were evaluated

  9. Exercise Physiology Ethnic Differences in Physiological Cardiac Adaptation to

    E-print Network

    Boyer, Edmond

    Exercise Physiology Ethnic Differences in Physiological Cardiac Adaptation to Intense Physical Exercise in Highly Trained Female Athletes J. Rawlins, MRCP; F. Carre, PhD; G. Kervio, PhD; M. Papadakis exercise in black female athletes is associated with greater left ventricular hypertrophy and higher

  10. The anatomy of the cardiac veins in mice

    PubMed Central

    Ciszek, Bogdan; Skubiszewska, Daria; Ratajska, Anna

    2007-01-01

    Although the cardiac coronary system in mice has been the studied in detail by many research laboratories, knowledge of the cardiac veins remains poor. This is because of the difficulty in marking the venous system with a technique that would allow visualization of these large vessels with thin walls. Here we present the visualization of the coronary venous system by perfusion of latex dye through the right caudal vein. Latex injected intravenously does not penetrate into the capillary system. Murine cardiac veins consist of several principal branches (with large diameters), the distal parts of which are located in the subepicardium. We have described the major branches of the left atrial veins, the vein of the left ventricle, the caudal veins, the vein of the right ventricle and the conal veins forming the conal venous circle or the prepulmonary conal venous arch running around the conus of the right ventricle. The venous system of the heart drains the blood to the coronary sinus (the left cranial caval vein) to the right atrium or to the right cranial caval vein. Systemic veins such as the left cranial caval, the right cranial caval and the caudal vein open to the right atrium. Knowledge of cardiac vein location may help to elucidate abnormal vein patterns in certain genetic malformations. PMID:17553104

  11. A Rare Case of Large Left Atrial Myxoma Associated with Carney Syndrome

    PubMed Central

    Kocabeyo?lu, Sinan Sabit; Özyüksel, Arda; Çetin, Erdem

    2014-01-01

    Abstract Carney Syndrome (CS) is an autosomal dominant multiple neoplasia syndrome that includes cardiac, endocrine, cutaneous, and neural tumors. Cardiac myxomas can be seen in the course of CS. A 46-year-old female patient was admitted to our clinic with palpitation, cough, and exertional dyspnea. Physical examination revealed pigmented lesions, especially scattered in the neck, chest, and extremities. Echocardiography revealed a left atrial mass, 6 × 4 cm in size, originating from the interatrial septum that was protruding into the left ventricle through the mitral valve during diastole. The tumor was excised from the interatrial septum with its pedicle. The patient was discharged at the fifth postoperative day without any complication. Cardiac myxomas are a cornerstone of this disease since cardiac manifestations and related complications account for the majority of mortality seen in the course of CS.

  12. Cardiac missiles. A review of the literature and personal experience.

    PubMed Central

    Symbas, P N; Picone, A L; Hatcher, C R; Vlasis-Hale, S E

    1990-01-01

    The management of retained missiles in the heart is still controversial. In an attempt to define the issue more clearly, the reported cases in the English literature from 1940 to 1988 (group 1) and our experience from 1968 to 1988 (group 2) were reviewed. In group 1 there were 222 missiles retained in the hearts of 201 patients. The retained missiles were 45 bullets in 45 patients, 109 shrapnel in 99 patients, 18 pellets in 7 patients, and 50 unidentified missiles in 50 patients. Thirteen of the missiles were completely embedded intramyocardial missiles, 122 were partially intramyocardial, 47 were free in a cardiac chamber, and 40 were intrapericardial. One hundred four of the missiles were removed and 118 were left in place. In group 2 there were 24 missiles, 18 bullets, 1 bullet fragment, and 5 pellets retained in the hearts of 24 patients. Ten missiles were removed, no attempt was made in 13 patients, and an unsuccessful attempt was made to remove one other. From group 1 patients, 6 died, 2 with intracavitary missiles, 3 patients with partially intramyocardial, and 1 patient with an intrapericardial missile, all of whom had either unsuccessful or no attempt to remove the missile. Twenty-seven patients had symptoms, all of whom, except two, had either unsuccessful or no attempt to remove the missile. All group 2 patients did well and had been free of symptoms related to the missiles. This review suggests that the management of missiles in the heart should be individualized according to the patient's clinical course, the site, shape, and size of the missile, and that in selected patients missiles in the heart are tolerated well. PMID:2187422

  13. No Cow Left Behind

    ERIC Educational Resources Information Center

    Remsen, Kenneth A.

    2004-01-01

    As a principal facing the task of figuring out all the complexities of the No Child Left Behind legislation, Kenneth Remsen, has concluded there is a strong belief that testing students is the answer to bringing about improvements in student performance. Because testing seems to be a cornerstone to improving performance, he doesn't understand why…

  14. The Children Left Behind

    ERIC Educational Resources Information Center

    Gillard, Sarah A.; Gillard, Sharlett

    2012-01-01

    This article explores some of the deficits in our educational system in regard to non-hearing students. It has become agonizingly clear that non-hearing students are being left out of the gallant sweep to enrich our children's educations. The big five areas of literacy, at best, present unique challenges for non-hearing students and, in some…

  15. Accountability Left Behind

    ERIC Educational Resources Information Center

    Testani, Rocco E.; Mayes, Joshua A.

    2008-01-01

    This article describes the reversal of the dismissal of an "unfunded-mandates" challenge to the No Child Left Behind Act (NCLB) brought by the National Education Association (NEA), several of its affiliates, and a number of school districts by the United States Court of Appeals for the Sixth Circuit. The decision in "School District of the City of…

  16. No Child Left Inside

    NSDL National Science Digital Library

    Ann E. Benbow

    2008-09-01

    Earth Science Week (ESW) 2008 encourages people around the globe to open doors and investigate new opportunities. This year's theme, "No Child Left Inside," is a call to explore our natural environments. The celebration urges everyone--especially young people--to venture outdoors and experience Earth science firsthand.

  17. No Child Left Inside!

    NSDL National Science Digital Library

    Ann E. Benbow

    2008-09-01

    Earth Science Week (ESW) 2008 encourages people around the globe to open doors and investigate new opportunities. This year's theme, "No Child Left Inside," is a call to explore our natural environments. The celebration urges everyone--especially young people--to venture outdoors and experience Earth science firsthand.

  18. Multiple cardiac thrombi and thromboembolism in a heparin-induced thrombocytopenia antibody-positive patient with heart failure.

    PubMed

    Wake, Ryotaro; Muro, Takashi; Hozumi, Takeshi; Matsumoto, Ryo; Kataoka, Toru; Nakamura, Yasuhiro; Takemoto, Yasuhiko; Takagi, Masahiko; Suehiro, Shigefumi; Yoshiyama, Minoru

    2008-11-01

    A 49-year-old Japanese man presented with orthopnea and edema in both legs. He was diagnosed with congestive heart failure with triple-vessel coronary artery disease. Low antithrombin and left ventricular systolic dysfunction were possible causes of his hypercoagulable state. Echocardiography revealed thrombi in the left ventricle and left trium, poor left ventricular contractility, and a normal mitral valve. Electrocardiogram revealed normal sinus rhythm. We found small infarctions of the brain and spleen in the computed tomography. The heparin treatment of cardiac thrombi is useless because the patient had heparin-induced thrombocytopenia antibody. We removed thrombi in the left ventricle and left atrium by thrombectomy and performed coronary artery bypass graft. Warfarin was administered for anticoagulation. He recovered completely and is now doing well. Our experience indicates that poor cardiac function can together cause multiple cardiac thrombi and subsequent thromboembolism without mitral stenosis or atrial fibrillation. PMID:19091284

  19. Is the human left ventricle partially a fractal pump?

    NASA Astrophysics Data System (ADS)

    Moore, Brandon; Dasi, Lakshmi

    2011-11-01

    Ventricular systolic and diastolic dysfunctions represent a large portion of healthcare problems in the United States. Many of these problems are caused and/or characterized by their altered fluid-structure mechanics. The structure of the left ventricle in particular is complex with time dependent multi-scale geometric complexity. At relatively small scales, one facet that is still not well understood is the role of trabeculae in the pumping function of the left ventricle. We utilize fractal geometry tools to help characterize the complexity of the inner surface of the left ventricle at different times during the cardiac cycle. A high-resolution three dimensional model of the time dependent ventricular geometry was constructed from computed tomography (CT) images in a human. The scale dependent fractal dimension of the ventricle was determined using the box-counting algorithm over the cardiac cycle. It is shown that the trabeculae may indeed play an integral role in the biomechanics of pumping by regulating the mechanical leverage available to the cardiac muscle fibers.

  20. Evaluation of cardiac function by tissue Doppler echocardiography: Hemodynamic determinants and clinical application

    Microsoft Academic Search

    Wen-Chung Yu; Wen-Shin Lee; Wen-Pin Huang; Chih-Cheng Wu; Yao-Ping Lin; Chen-Huan Chen

    2005-01-01

    A total of 32 patients without regional wall motion abnormality of the left ventricle underwent sequential tissue Doppler echocardiography and cardiac catheterization. Peak velocities of systolic (Sa), early diastolic (Ea), and late diastolic (Aa) motion of the mitral annulus were measured. Normal references for Sa, Ea and Aa were obtained from 138 volunteers. Indices of left ventricular (LV) systolic and

  1. Slow continuous ultrafiltration in a patient with anomaly of a persistent left superior vena cava.

    PubMed

    Aperis, Georgios; Paliouras, Christos; Moschos, Nikitas; Tsampikaki, Eirini; Alivanis, Polichronis

    2012-09-01

    This paper describes an uncommon case of a patient with anomaly of a persistent left superior vena cava (PLSVC). A 54-year-old man with a history of chronic kidney disease, heart failure, diabetes mellitus and hypertension was admitted to the hospital for worsening dyspnoea. During his hospital stay, heart failure was further deteriorated and he became anuric. Renal replacement therapy was then required. After multiple unsuccessful attempts of right subclavian vein catheterisation, a catheter was placed in the left subclavian vein. Chest X-ray revealed the catheter in the left side of the thorax. Transthoracic cardiac ultrasound with agitated saline and chest MRI confirmed the diagnosis of PLSVC. The patient had nine sessions of slow continuous ultrafiltration. His heart and renal function were gradually improved. Nephrologists and health care professionals must be aware of this uncommon anatomic variant. Unnecessary manipulations can lead to serious complications, such as cardiac arrhythmias, cardiac arrest and venous sinus thrombosis. PMID:22449136

  2. Percutaneous closure of a coronary fistula between the right coronary artery to the left atrium.

    PubMed

    Drago, Manuela; Chessa, Massimo; Gianfranco, Butera; Bossone, Eduardo; Carminati, Mario

    2004-01-01

    We describe a case of a congenital coronary artery fistula of the right coronary artery draining into the left atrium in an eight-year-old boy. The initial diagnosis was made after the detection of a continuous cardiac murmur at the age of six years. Transthoracic echocardiography showed the right coronaric ostium dilatation, the site of drainage in the left atrium and left ventricle volume overload. Catheterization confirmed the diagnosis. The patient underwent percutaneous closure by PDA occluder device. Immediate post-closure angiograms showed complete occlusion of the fistula. The patient showed transient ischemic changes on ECG associated to an increase of plasmatic levels of the cardiac enzyme. ECG and cardiac enzyme were normal one week after the procedure. PMID:16146912

  3. Displacement and Velocity of the Coronary Arteries: Cardiac and Respiratory Motion

    PubMed Central

    Shechter, Guy; Resar, Jon R.; McVeigh, Elliot R.

    2007-01-01

    This paper presents measurements of three-dimensional (3-D) displacements and velocities of the coronary arteries due to the myocardial beating motion and due to breathing. Data were acquired by reconstructing the coronary arteries and their motion from biplane angiograms in 10 patients. A parametric motion model was used to separate the cardiac and breathing motion fields. The arteries move consistently toward the left, inferior, and anterior during a cardiac contraction. The displacement and velocity of the right coronary artery during a cardiac contraction was larger than measured for the left coronary tree. Cardiac motion dominates the respiratory motion of the coronary arteries during spontaneous breathing. On inspiration, the arteries move caudally, but the motion in the left-right and anterior-posterior axes was variable. Spatial variation in respiratory displacement and velocity of the coronary arteries indicates that the breathing motion of the heart is more complex than a 3-D translation. PMID:16524092

  4. Pacemaker lead malposition in the left atrial roof is masked by normal pacing thresholds

    PubMed Central

    2014-01-01

    Pacemaker lead malpositioning with subsequent cardiac tamponade is a rare, but serious adverse event. We herein report a case of pacemaker lead malpositioning in a 76-year old female caucasian patient. The lead was malpositioned into the roof of the left atrium after perforation of the superior vena cava, resulting in cardiac tamponade. After fast surgical revision and an uneventful post-operative period, the patient was discharged in excellent condition. PMID:24650143

  5. Sudden death in a 15-year-old with diffuse cardiac rhabdomyomatosis: an autopsy case report.

    PubMed

    Fuller, Maren Y; Wolf, Dwayne A; Buja, L Maximilian

    2014-01-01

    A 15-year-old African-American female with a 4-month history of sporadic rapid heartbeat and fatigue was found pulseless and apneic in her residence. At autopsy, patchy scarring was diffuse throughout the circumference of the left ventricle of the heart. Microscopically, the myocardium had diffuse infiltration of rhabdomyoma-like cells with significant associated fibrosis. Unlike cardiac rhabdomyoma, there was no discrete tumor mass. Differential diagnoses considered were congenital cardiac rhabdomyoma with partial regression, cardiac fibroma, histiocytoid cardiomyopathy, glycogen storage diseases, and drug-induced vacuolar cardiomyopathy. However, the findings are most consistent with cardiac rhabdomyomatosis, an entity not well described in the literature. PMID:25130767

  6. The Juelich large Aerosol Chamber

    Microsoft Academic Search

    Th. Mentel; A. Wahner; M. Folkers

    2003-01-01

    The large Aerosol Chamber is designed for the investigation of nighttime atmospheric chemistry. The Aerosol Chamber is a dark chamber and is operated at ambient temperature and pressure conditions. It is constructed as a double wall system: a fully welded aluminum box (7m x 7m x 5.3m) and an equally sized fully heat sealed Teflon bag hanging from the ceiling.

  7. Cardiac tissue Doppler imaging in sports medicine.

    PubMed

    Krieg, Anne; Scharhag, Jürgen; Kindermann, Wilfried; Urhausen, Axel

    2007-01-01

    The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard. Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions. For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI. Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking. An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation. PMID:17190533

  8. Cardiac and neurological abnormalities in v-fps transgenic mice.

    PubMed Central

    Yee, S P; Mock, D; Maltby, V; Silver, M; Rossant, J; Bernstein, A; Pawson, T

    1989-01-01

    Transgenic mice that widely express the v-fps protein-tyrosine kinase develop several independent pathological conditions, in addition to a high tumor incidence. v-fps expression and protein-tyrosine kinase activity in the heart were directly correlated with cardiac enlargement. This cardiomegaly was accompanied by severe myocardial and endocardial damage, which was concentrated in the left ventricular wall, and characterized by a progressive atrophy and necrosis of cardiac muscle fibers with concomitant fibrosis. This pathology was associated with congestive heart failure. Mice from five lines developed a marked trembling, correlated with expression of the v-fps transgene in the brain, and two lines showed a striking bilateral enlargement of the trigeminal nerves. Unlike tumor formation, these cardiac and neurological phenotypes were evident shortly after birth and showed 100% penetrance. The pleiotropic effects of the v-fps transgene suggest the involvement of protein-tyrosine kinases in mammalian neural development and cardiac function. Images PMID:2788278

  9. Postgraduate in Cardiac Electrophysiology

    E-print Network

    Einmahl, Uwe

    and myocardial infarction), · Diseases affecting the mechanical function of the heart (heart failure), · Diseases by an acute obstruction of a coronary artery can cause acute heart failure and acute arrhythmias that may lead to cardiogenic shock or sudden cardiac death. Cardiac arrhythmias can also cause heart failure and heart failure

  10. What Is Cardiac Rehabilitation?

    MedlinePLUS

    ... if your doctor says you can. • Have your heart rate, blood pressure and EKG monitored. A cardiac rehabilitation (rehab) program takes place in a hospital or in the community. Cardiac rehab is for patients who are getting better after heart problems or surgery. One of the best things ...

  11. Prospectively gated cardiac CT

    Microsoft Academic Search

    Dominic Heuscher; S. Zabic

    2007-01-01

    Future cardiac CT protocols will utilize large area detectors with whole heart scans performed within one heartbeat. For such scans, accurate prospective ECG gating is essential to capture the heart at the correct phase. This report addresses one of the main factors affecting the prospective gating accuracy: the ability to predict the cardiac phase from the ECG signal. Two different

  12. Cardiac risk telemonitoring

    Microsoft Academic Search

    H. Hutten; M. Hribernigg; G. Rauchegger

    2001-01-01

    Utilization of advanced information, telecommunication and implant technology for cardiac risk stratification and management is one of the greatest challenges for modern health care provision. Sudden cardiac death is the major contributor to overall cardiovascular mortality with approximately 60% of all coronary heart disease fatalities occurring annually. Although some high-risk patient groups have been identified with reasonable sensitivity and specificity

  13. Garfinkel Cardiac Data

    NSDL National Science Digital Library

    Alan Garfinkel (University of California Los Angeles; Physiological Sci/Med-Cardio)

    2009-01-10

    Cardiac data on multiple variables for a selected population of 220 men and 338 women participating in a drug treatment study of dobutamine for heart attack prevention. Garfinkel, Alan, et. al. "Prognostic Value of Dobutamine Stress Echocardiography in Predicting Cardiac Events in Patients With Known or Suspected Coronary Artery Disease." Journal of the American College of Cardiology 33.3 (1999) 708-16.

  14. Environmental calibration chamber operations

    NASA Technical Reports Server (NTRS)

    Lester, D. L.

    1988-01-01

    Thermal vacuum capabilities are provided for the development, calibration, and functional operation checks of flight sensors, sources, and laboratory and field instruments. Two systems are available. The first is a 46 cm diameter diffusion pumped vacuum chambler of the bell jar variety. It has an internal thermal shroud, LN2 old trap, two viewing ports, and various electrical and fluid feedthroughs. The other, also an oil diffusion pumped system, consists of a 1.8 m diameter by 2.5 m long stainless steel vacuum tank, associated pumping and control equipment, a liquid nitrogen storage and transfer system and internal IR/visible calibration sources. This is a two story system with the chamber located on one floor and the pumping/cryogenic systems located on the floor below.

  15. Chambers's Book of Days

    NSDL National Science Digital Library

    Subtitled A Miscellany of Popular Antiquities in connection with the Calendar, Chambers's Book of Days is essentially a collection of "On this Day" trivia, short pieces, and other interesting tidbits, including history, literature, biography, and "oddities of human life and character." Digitized by the University of Wisconsin-Madison Libraries, this electronic reprint may be browsed in page order or via a calendar navigator. The site offers a fun look into pop-history/ tabloid news of the late nineteenth century. For instance, I discovered that on the day of my birth in 1626 "a cod-fish was brought to Cambridge market, which upon being opened, was found to contain a book in its maw or stomach." An auspicious date to be born indeed.

  16. Iran Chamber Society

    NSDL National Science Digital Library

    In 2001, the Iran Chamber Society was created in order to provide a non-partisan, non-commercial, comprehensive source of information on Iran. The website's "About Us" section states that their aim is to "create a global awareness about Iranian society and eradicate the misunderstandings and misconceptions about Iranian society, and to play an educational role as well." Visitors will find the website divided up into "Art and Culture", "History", "Society" and "Iran's Guide". The "Exhibitions and Conferences" link on the right side of the homepage leads visitors to a number of exhibitions, including the fascinating "Artistic Murals of Tehran's Metro Stations", which offers a dozen pictures of the beautifully handcrafted murals made of pottery, metal, cement and other materials. The "History" section offers pictures and documents, including some disturbing graphic photos from the Iran-Iraq War in 1980-1988 that appear at the end of the Historic Periods and Events section.

  17. Mush Column Magma Chambers

    NASA Astrophysics Data System (ADS)

    Marsh, B. D.

    2002-12-01

    Magma chambers are a necessary concept in understanding the chemical and physical evolution of magma. The concept may well be similar to a transfer function in circuit or time series analysis. It does what needs to be done to transform source magma into eruptible magma. In gravity and geodetic interpretations the causative body is (usually of necessity) geometrically simple and of limited vertical extent; it is clearly difficult to `see' through the uppermost manifestation of the concentrated magma. The presence of plutons in the upper crust has reinforced the view that magma chambers are large pots of magma, but as in the physical representation of a transfer function, actual magma chambers are clearly distinct from virtual magma chambers. Two key features to understanding magmatic systems are that they are vertically integrated over large distances (e.g., 30-100 km), and that all local magmatic processes are controlled by solidification fronts. Heat transfer considerations show that any viable volcanic system must be supported by a vertically extensive plumbing system. Field and geophysical studies point to a common theme of an interconnected stack of sill-like structures extending to great depth. This is a magmatic Mush Column. The large-scale (10s of km) structure resembles the vertical structure inferred at large volcanic centers like Hawaii (e.g., Ryan et al.), and the fine scale (10s to 100s of m) structure is exemplified by ophiolites and deeply eroded sill complexes like the Ferrar dolerites of the McMurdo Dry Valleys, Antarctica. The local length scales of the sill reservoirs and interconnecting conduits produce a rich spectrum of crystallization environments with distinct solidification time scales. Extensive horizontal and vertical mushy walls provide conditions conducive to specific processes of differentiation from solidification front instability to sidewall porous flow and wall rock slumping. The size, strength, and time series of eruptive behavior of the system, coupled with these processes, define the fundamental compositional and dynamic diversity of the Mush Column. In some ways it functions like a complex musical instrument. Entrainment, transport, and sorting of cumulate crystals as a function of repose time and the local flux intensity also contribute to the basic compositional diversity of the system. In the Ferrar dolerite system, about 104 km3 of dolerite is distributed throughout a fir-tree like stack of 4 or 5 extensive 300-750 m thick sills. The lowest sill contains a vast tongue of entrained orthopyroxene (opx) cumulates emplaced with the sill itself. The bulk sill composition varies from 20 pc MgO in the tongue center to 7 pc in the leading tip and margins of the sill, which itself defines the compositional spectrum of the whole complex and is remarkably similar to that exhibited by Hawaii. Relative sorting of large (1-50 mm) opx and small (1-3 mm) plagioclase due to kinetic sieving in the tongue produces pervasive anorthosite stringers. Through local ponding this has culminated in the formation of a small, well-formed layered intrusion consisting of alternating layers of orthopyroxenite and anorthosite. Upwards in the system the sills become progressively depleted in MgO and temporally and spatially contiguous flood basalts are low MgO tholeiites with no sign of opx cumulates. The size, extent, number of sills, and the internal structure of individual sills suggest a rhythm of injection similar to that of volcanic episodes. The continued horizontal stretching of a system of this type would lead to processes as recorded by ophiolites, and the repeated injection into a single reservoir would undoubtedly lead to a massive layered intrusion or to a series of high-level nested plutons.

  18. Fast ion chambers for SLC

    SciTech Connect

    McCormick, D.

    1993-07-01

    Beam diagnostic ion chambers are used throughout the SLC to perform a variety of tasks including locating beam losses along the beam direction, determining localized losses from individual bunches in a multibunch beam, and detecting scattered particles from beam profile wire scanners where backgrounds are too high to use photomultiplier tubes. Construction and instrumentation of very fast ion chambers with pulse duration of less than 60ns are detailed. Long ion chambers referred to as PLIC (Panofsky`s Long Ion Chamber) are the primary diagnostic used to locate losses in all the SLC transport lines. Accurately locating beam loss with the use of fiducial cables and coaxial switches will be discussed.

  19. Neutron Detection via Bubble Chambers

    SciTech Connect

    Jordan, David V.; Ely, James H.; Peurrung, Anthony J.; Bond, Leonard J.; Collar, J. I.; Flake, Matthew; Knopf, Michael A.; Pitts, W. K.; Shaver, Mark W.; Sonnenschein, Andrew; Smart, John E.; Todd, Lindsay C.

    2005-10-06

    The results of a Pacific Northwest National Laboratory (PNNL) exploratory research project investigating the feasibility of fast neutron detection using a suitably prepared and operated, pressure-cycled bubble chamber are described. The research was conducted along two parallel paths. Experiments with a slow pressure-release Halon chamber at the Enrico Fermi Institute at the University of Chicago showed clear bubble nucleation sensitivity to an AmBe neutron source and insensitivity to the 662 keV gammas from a 137Cs source. Bubble formation was documented via high-speed (1000 frames/sec) photography, and the acoustic signature of bubble formation was detected using a piezo-electric transducer element mounted on the base of the chamber. The chamber’s neutron sensitivity as a function of working fluid temperature was mapped out. The second research path consisted of the design, fabrication, and testing of a fast pressure-release Freon-134a chamber at PNNL. The project concluded with successful demonstrations of the PNNL chamber’s AmBe neutron source sensitivity and 137Cs gamma insensitivity. The source response tests of the PNNL chamber were documented with high-speed photography.

  20. Clinical and haemodynamic effects of milrinone in the treatment of low cardiac output after cardiac surgery.

    PubMed

    Wright, E M; Sherry, K M

    1991-11-01

    We have studied the haemodynamic effects of i.v. milrinone, a new phosphodiesterase inhibitor, in patients with low cardiac output after cardiac surgery. Thirty-five patients with a cardiac index (Cl) less than 2.5 litre min-1 m-2 and a pulmonary capillary wedge pressure (PCWP) greater than 8 mm Hg were given a loading dose of milrinone 50 micrograms kg-1 followed by an infusion at one of three rates: 0.375 micrograms kg-1 min-1, 0.5 micrograms kg-1 min-1 or 0.75 micrograms kg-1 min-1 for 12 h. After 1 h there were increases in Cl (35%) (P less than 0.001), heart rate (13%) (P less than 0.01) and stroke volume index (19%) (P less than 0.005). There were decreases in mean arterial pressure (12%) (P less than 0.01), systemic vascular resistance (35%) (P less than 0.001) and PCWP (24%) (P less than 0.05). Pulmonary vascular resistance was unchanged or reduced and left ventricular stroke work index was unchanged or increased. The haemodynamic improvements were sustained throughout the infusion period. Milrinone was tolerated well: three patients developed tachycardia greater than 125 beat min-1, one patient developed atrial fibrillation and one patient had a short run of atrial bigemini. We conclude that milrinone is a useful agent in the treatment of patients with a reduced cardiac output after cardiac surgery. PMID:1751273