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"Cases of SCMR" is a case series on the SCMR website (https://www.scmr.org) for the purpose of education. The cases reflect the clinical presentation, and the use of cardiovascular magnetic resonance (CMR) in the diagnosis and management of cardiovascular disease. The 2022 digital collection of cases are presented in this manuscript.
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Doenças Cardiovasculares , Valor Preditivo dos Testes , Humanos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/terapia , Pessoa de Meia-Idade , Feminino , Masculino , Idoso , Imageamento por Ressonância Magnética , Adulto , Prognóstico , Adulto JovemRESUMO
INTRODUCTION: The gold standard for identifying and grading tricuspid valve regurgitation is transthoracic echocardiography. However, the acoustic window using transthoracic echocardiography is not always sufficient to quantify the amount of regurgitation. Time-resolved imaging of contrast kinetics (TRICKS) is a 4-dimensional magnetic resonance angiography option with high spatial and temporal resolution. The aim of the present study is to find out whether identification of patients with severe tricuspid valve regurgitation by using TRICKS angiography is feasible. METHODS: TRICKS angiography was performed in a 3T-CMR-scanner after antecubital injection of gadolinium dimeglumine during breath hold. Retrograde appearance of contrast agent in the hepatic veins was classified as severe tricuspid regurgitation (TR). Additional semi quantification of retrograde perfusion was performed by temporal signal intensity curve (SIC) analysis in the hepatic veins close to their drainage into the inferior vena cava. Transthoracic echocardiography (TTE) using the actual European guidelines on the management of valvular heart disease served as gold standard forTR grading. RESULTS: 185 patients (57 +/- 17 years) with TR ranging from no to severe TR were analysed prospectively. 14 (7.6%) patients had severe TR, 27 (14.6%) showed moderate, 137 (74.1%) mild and 7 (3.8%) no TR. TRICKSangiography identified 13 patients with retrograde contrast appearance in the hepatic veins, of whom all had severe TR in TTE. No patient with echocardiographic mild or moderate TR was graded as severe TR using TRICKSangiography. One patient with echocardiographic severe TR showed neither in the visual analysis nor in SIC analysis retrograde appearance of contrast agent in the hepatic veins. Overall, the sensitivity for detecting severe TR using TRICKSangiography was 93% with a specificity of 100%. The positive predictive value was 100%, the negative predictive value 99%. For severe TR there was no intra- and interobserver variability. CONCLUSION: MRTRICKSangiography is a very reliable tool to identify patients with severeTR by the imaging of retrograde appearance of contrast agent in the hepatic veins. Sensitivity and specificity of this approach is very high with no intra- and interobserver variability.
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Velocidade do Fluxo Sanguíneo , Meios de Contraste , Gadolínio DTPA , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/instrumentação , Insuficiência da Valva Tricúspide/diagnóstico , Idoso , Ecocardiografia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Insuficiência da Valva Tricúspide/fisiopatologiaRESUMO
BACKGROUND: Stress-rest perfusion magnetic resonance imaging (MRI) has become one of the major indications for cardiovascular MRI. Standard multibreath hold short-axis image acquisition is the gold standard for LV function assessment and part of a comprehensive stress-rest perfusion MRI study, but takes up to 10 min. The total scan time could significantly be shortened when cine imaging would be performed between stress and rest perfusion. PURPOSE: To systematically study whether adenosine, albeit its short half-life time, influences LV function measurements in this setting. MATERIAL AND METHODS: Thirty-nine patients with suspected and/or known coronary artery disease underwent 3-Tesla adenosine (140 µg/min/kg) stress-rest perfusion MRI. A stack of short-axis slices covering the entire ventricles was acquired before and ≥3 min after adenosine infusion using standard multibreath-hold 2D steady-state free precession imaging. LV volumes (EDV, ESV), EF, and mass were calculated by the slice summation method, and wall motion was assessed using a 4-point scoring scale. Reproducibility was assessed by Bland-Altman statistics. RESULTS: EDV, ESV, EF, and mass were not significantly different between the two imaging time points (before versus after adenosine administration) in all patients (P ≥ 0.346) and patients with impaired LV function (P ≥ 0.718). Wall motion scores did not differ either (P ≥ 0.124). Inter-observer variability before (P ≥ 0.468) and after (P ≥ 0.451) adenosine infusion was low. CONCLUSION: Short-axis cine imaging for LV function assessment can accurately be performed between stress and rest imaging. These data demonstrate that potential effects of adenosine on LV function are of short duration, and propose a new time-saving imaging protocol without compromising accuracy.
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Adenosina/farmacologia , Doença da Artéria Coronariana/diagnóstico , Teste de Esforço/métodos , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Vasodilatadores/farmacologia , Disfunção Ventricular Esquerda/diagnóstico , Adulto , Idoso , Meios de Contraste , Doença da Artéria Coronariana/fisiopatologia , Eletrocardiografia , Feminino , Gadolínio DTPA , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: Three Tesla cardiovascular magnetic resonance imaging (3T-CMR) is increasingly used in clinical practice. Despite many advantages one drawback is that ECG signal disturbances and artifacts increase with higher magnetic field strength resulting in trigger problems and false gating. This particularly affects cardiac imaging because most pulse sequences require ECG triggering. Pulse wave (PW) triggering is robust and might have advantages over ECG triggering. PURPOSE: To evaluate differences in left ventricular (LV) function as an integral part of most CMR studies between ECG- and PW-triggered short-axis imaging using 3T-CMR. MATERIAL AND METHODS: Forty-three patients underwent multiple short-axis cine imaging for LV-function assessment with ECG and PW triggering using standard multibreath hold steady-state free precession. LV-volumes (EDV, ESV), ejection fraction (EF), and mass were determined by slice summation. LV-wall motion was assessed by using a 4-point scoring scale. Bland Altman statistics for inter-observer variability were performed. RESULTS: ECG triggering failed in 15 patients (34.8%). Thus, analysis was performed in 28 patients (13 with impaired LV function). Difference in volumes (EDV 0.13 ± 1.8 mL, ESV 0.59 ± 1.1 mL), EF (-0.32 ± 0.6%) and mass (0.01 ± 1.1 g) between ECG and PW triggering were very small and significant only for ESV and EF (p ≤ 0.011). In patients with impaired LV function (n = 19) differences were not significant (p ≥ 0.128). Wall motion scores did not differ between ECG and PW triggering (p ≥ 0.295). Inter-observer variability for function measurements was low. CONCLUSION: Short-axis cine imaging for LV-function assessment can accurately be performed using PW triggering on 3T magnets, and may be used in clinical practice when ECG triggering is disturbed.
Assuntos
Eletrocardiografia , Imagem Cinética por Ressonância Magnética/métodos , Função Ventricular Esquerda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Volume SistólicoRESUMO
OBJECTIVE: Multi-breath hold cine-imaging (standard-2D-SSFP) is the standard technique for ventricular function assessment. However, image acquisition is time-consuming and breath holding is required. Ultrafast 2D real-time imaging (2D real time-SSFP) does not require breath holding, but spatial resolution is sacrificed. The accuracy of 2D real time-SSFP free-breathing ventricular function assessment by using an automated contour detection programme has not been systematically studied. METHODS AND RESULTS: Twenty-eight subjects (14 with impaired LV function) were investigated by 1.5 Tesla magnetic resonance imaging. Left ventricular short-axis images were acquired with multi-breath hold standard 2D-SSFP and free-breathing 2D real time-SSFP. LV-volumes (EDV, ESV), EF, and mass were determined using a semi-automated contour detection programme. EDV, ESV, EF, and mass were not significantly different between real time- and standard 2D-SSFP in subjects (absolute differences: EDV 3.2 +/- 0.7 mL, ESV 3.0 +/- 0.3 mL, EF 1.9 +/- 0.4%, mass 0.8 +/- 0.4 g; P > or = 0.78) and patients (absolute differences: EDV= 3.0 +/- 0.8 mL, ESV 3.3 +/- 1.0 mL, EF 0.9 +/- 0.5%, mass 0.9 +/- 0.5 g; P > or = 0.73). Automated contour detection required extensive manual correction for real-time imaging (< or = 86%). CONCLUSIONS: Differences in LV function measurements between real-time and standard 2D-SSFP are small, and not significant. Real-time SSFP may be used for rapid LV function assessment when examination time is limited.
Assuntos
Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Papillary muscles and trabeculae for ventricular function analysis are known to significantly contribute to accurate volume and mass measurements. Fast imaging techniques such as three-dimensional steady-state free precession (3D SSFP) are increasingly being used to speed up imaging time, but sacrifice spatial resolution. It is unknown whether 3D SSFP, despite its reduced spatial resolution, allows for exact delineation of papillary muscles and trabeculations. We therefore compared 3D SSFP ventricular function measurements to those measured from standard multi-breath hold two-dimensional steady-state free precession cine images (standard 2D SSFP). METHODS AND RESULTS: 14 healthy subjects and 14 patients with impaired left ventricularfunction underwent 1.5 Tesla cine imaging. A stack of short axis images covering the left ventricle was acquired with 2D SSFP and 3D SSFP. Left ventricular volumes, ejection fraction, and mass were determined. Analysis was performed by substracting papillary muscles and trabeculae from left ventricular volumes. In addition, reproducibility was assessed. EDV, ESV, EF, and mass were not significantly different between 2D SSFP and 3D SSFP (mean difference healthy subjects: -0.06 +/- 3.2 ml, 0.54 +/- 2.2 ml, -0.45 +/- 1.8%, and 1.13 +/- 0.8 g, respectively; patients: 1.36 +/- 2.8 ml, -0.15 3.5 ml, 0.86 +/- 2.5%, and 0.91 +/- 0.9 g, respectively; P > or = 0.095). Intra- and interobserver variability was not different for 2D SSFP (P > or = 0.64 and P > or = 0.397) and 3D SSFP (P > or = 0.53 and P > or = 0.47). CONCLUSIONS: Differences in volumes, EF, and mass measurements between 3D SSFP and standard 2D SSFP are very small, and not statistically significant. 3D SSFP may be used for accurate ventricular function assessment when papillary muscles and trabeculations are to be taken into account.
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Imagem Cinética por Ressonância Magnética/métodos , Músculos Papilares/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Diástole/fisiologia , Feminino , Coração/fisiopatologia , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Sístole/fisiologiaRESUMO
PURPOSE: To prospectively analyze the myocardial distribution of late gadolinium enhancement (LGE) with delayed-enhancement cardiac magnetic resonance (MR) imaging, to compare the prevalence of this distribution in nonprofessional male marathon runners with that in asymptomatic control subjects, and to examine the prognostic role of LGE. MATERIALS AND METHODS: Institutional review board and ethics committee approval were obtained for this study, and all subjects provided written informed consent. Two-dimensional inversion-recovery segmented k-space gradient-echo MR sequences were performed after administration of a gadolinium-containing contrast agent in 102 ostensibly healthy male runners aged 50-72 years who had completed at least five marathons during the past 3 years and in 102 age-matched control subjects. Predominantly subendocardial regions of LGE typical of myocardial infarction (hereafter, coronary artery disease [CAD] pattern) were distinguished from a predominantly midmyocardial patchy pattern of LGE (hereafter, non-CAD pattern). Marathon runners with LGE underwent repeat cardiac MR imaging and additional adenosine perfusion imaging. Runners were followed up for a mean of 21 months +/- 3 (standard deviation) after initial presentation. The chi(2), Fisher exact, and McNemar exact tests were used for comparisons. Event-free survival rates were estimated with the Kaplan-Meier method, and overall group differences were evaluated with log-rank statistics. RESULTS: Of the 102 runners, five had a CAD pattern of LGE, and seven had a non-CAD pattern of LGE. The CAD pattern of LGE was located in the territory of the left anterior descending coronary artery more frequently than was the non-CAD pattern (P = .0027, Fisher exact test). The prevalence of LGE in runners was higher than that in age-matched control subjects (12% vs 4%; P = .077, McNemar exact test). The event-free survival rate was lower in runners with myocardial LGE than in those without myocardial LGE (P < .0001, log-rank test). CONCLUSION: Ostensibly healthy marathon runners have an unexpectedly high rate of myocardial LGE, and this may have diagnostic and prognostic relevance.
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Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Gadolínio , Imageamento por Ressonância Magnética/estatística & dados numéricos , Corrida/estatística & dados numéricos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologia , Idoso , Causalidade , Comorbidade , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Resistência Física , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: An ultrafast, delayed contrast-enhancement cardiovascular magnetic resonance technique that can acquire subsecond, "snapshot" images during free breathing (subsecond) is becoming widely available. This technique provides myocardial infarction (MI) imaging with complete left ventricular coverage in < 30 seconds. However, the accuracy of this technique is unknown. METHODS AND RESULTS: We prospectively compared subsecond imaging with routine breath-hold delayed contrast-enhancement cardiovascular magnetic resonance (standard) in consecutive patients. Two cohorts with unambiguous standards of truth were prespecified: (1) patients with documented prior MI (n=135) and (2) patients without MI and with low likelihood of coronary disease (lowest Framingham risk category; n=103). Scans were scored masked to identity and clinical information. Sensitivity, specificity, and accuracy of subsecond imaging for MI diagnosis were 87%, 96%, and 91%, respectively. Compared with the standard technique (98%, 100%, 99%), the subsecond technique had modestly reduced sensitivity (P=0.0001), but specificity was excellent. Missed infarcts were generally small or subendocardial (87%). Overall, regional transmural extent of infarction scores were highly concordant (2083/2294; 91%); however, 51 of 337 regions (15%) considered predominantly infarcted (> 50% transmural extent of infarction) by the standard technique were considered viable (< or = 25% transmural extent of infarction) by the subsecond technique. Quantitative analysis demonstrated moderately reduced contrast-to-noise ratios for subsecond imaging between infarct and remote myocardium (12.0+/-7.2 versus 20.1+/-6.6; P<0.0001) and infarct and left ventricular cavity (-2.5+/-2.7 versus 3.6+/-3.7; P<0.0001). CONCLUSIONS: MI can be rapidly detected by subsecond delayed contrast-enhancement cardiovascular magnetic resonance during free breathing with high accuracy. This technique could be considered the preferred approach in patients who are more acutely ill or unable to hold their breath. However, compared with standard imaging, sensitivity is mildly reduced, and the transmural extent of infarction may be underestimated.
Assuntos
Imageamento por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico , Respiração , Adulto , Idoso , Estudos de Coortes , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Mecânica Respiratória/fisiologia , Fatores de TempoRESUMO
PURPOSE: To prospectively compare in canines the diagnostic accuracy for myocardial infarction (MI) of standard delayed-enhancement (DE) magnetic resonance (MR) imaging versus that of subsecond DE MR imaging with and without breath holding and/or cardiac arrhythmia, with histologic findings or absence of surgical creation of MI as the reference standard. MATERIALS AND METHODS: This study was approved by the Institutional Animal Care and Use Committee; 21 canines were imaged with one standard and two subsecond DE MR techniques in four conditions: condition 1, breath holding and steady gating; 2, non-breath holding and steady gating; 3, breath holding and irregular heart rhythm; and 4, non-breath holding and irregular heart rhythm. Images were randomized and scored for diagnostic accuracy, image quality, and observer confidence. Sensitivity, specificity, and diagnostic accuracy for MI detection were calculated for each technique and clinical condition separately. The chi(2), paired t, and McNemar tests were used for comparisons. RESULTS: Fifteen dogs had MIs. Among conditions 2-4, differences were not significant (P > .05); data were pooled and referred to as group B. Condition 1 was group A. Accuracy, image quality, and observer confidence, respectively, for standard DE MR imaging were 96%, 3.7 +/- 0.8, and 2.7 +/- 0.6 in group A but only 74%, 2.4 +/- 0.8, and 1.8 +/- 0.7 in group B (P < or = .004 for each). Corresponding scores for subsecond techniques were unaffected by respiratory motion and/or arrhythmia. Subsecond techniques had higher accuracy (82% and 86% vs 74%), better image quality (3.9 +/- 0.7 and 3.2 +/- 0.8 vs 2.4 +/- 0.8), and greater confidence (2.4 +/- 0.7 and 2.1 +/- 0.7 vs 1.8 +/- 0.7) (P < or = .0002 for each) than standard DE MR imaging. In group A, standard performed better than subsecond DE MR imaging. CONCLUSION: Standard DE MR imaging is appropriate for MI detection with breath holding and regular heart rhythm, while subsecond techniques are appropriate with an irregular heart rhythm and when breath holding is not possible.
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Arritmias Cardíacas/complicações , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Respiração , Animais , Cães , Imageamento por Ressonância Magnética/métodos , Movimento , Infarto do Miocárdio/fisiopatologia , Miocárdio/patologia , Intensificação de Imagem Radiográfica , Sensibilidade e EspecificidadeRESUMO
PURPOSE: The aim of this study was to compare the visual and quantitative assessment for left ventricular ejection fraction (LVEF) in normal subjects and patients with impaired LV function. METHODS: One hundred subjects (40 normal subjects, 40 patients with ischemic cardiomyopathy, and 20 patients with nonischemic cardiomyopathy) were investigated using a 1.5-T cardiovascular magnetic resonance imager. Images were acquired by a fast gradient-echo sequence with steady-state free precession using the standard short-axis method. Left ventricular EF was calculated from the sums of the outlined areas using the Simpson rule. Interobserver variability between the calculated and the visual EF was assessed. Analyses were performed randomly and blinded by 2 independent observers. RESULTS: Left ventricular EF was significantly underestimated by the visual read in all 3 groups (mean difference: normal subjects -2.6% +/- 2.6%, ischemic cardiomyopathy -1.7% +/- 2.1%, and nonischemic cardiomyopathy -1.2% +/- 2.1%; P < or = .02). The difference was larger in normal subjects than in patients with cardiomyopathy (P = .04). The interobserver variability was smaller for the quantitative assessment than for the visual estimation. CONCLUSION: Left ventricular EF is underestimated by visual estimation compared with the quantitative assessment. The visual approach for EF assessment may be used for rapid assessment of left ventricular function in clinical practice where accuracy is of less concern. For most accurate analysis, the quantitative standard short axis approach is required.
Assuntos
Imageamento por Ressonância Magnética , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
There is a complex interaction between the heart and the lungs. We report on a healthy female who performs breath hold diving at a high, international level. In order to optimize pressure equalization during diving and to increase oxygen available, apneists employed a special breathing maneuver, so called "lung packing". Based on cardiac MRI we could demonstrate impressive effects of this maneuver on left ventricular geometry and hemodynamics. Beyond the fact, that our findings support the concept of pulmonary -cardiac interrelationship, it should be emphasized, that the reported, extreme breathing maneuver could have detrimental consequences due to reduction of stroke volume and cardiac output.
RESUMO
Cardiovascular magnetic resonance (CMR) using contrast enhancement allows exact determination of the site and transmural extent of myocardial infarction (MI). We evaluated whether 12-lead electrocardiography can differentiate transmural from non-transmural MI or determine the site of MI by comparing the findings with those of contrast-enhanced CMR. A total of 27 patients (59.5+/-12.9 years) with a history of MI (6.4+/-2.9 months) underwent CMR (Magnetom, Siemens, Erlangen, Germany). Cine images were acquired in the horizontal and vertical long axes and short axis by TrueFISP. Contrast-enhanced CMR images were acquired in the same axes by segmented FLASH 15 min after administration of gadolinium-DTPA (0.15 mmol/kg). This showed the MI to be transmural in 11 patients and non-transmural in 16. An electrocardiogram (ECG) was recorded in all patients before CMR. T-wave alterations, descending ST-depression, pathological Q-waves and absent R waves were more frequent in non-transmural MI than transmural MI, as defined by contrast-enhanced CMR (p> or =0.618). However, none of the differences were statistically significant. R-wave reduction, q waves and horizontal ST-depression were more frequent in transmural than in non-transmural MI (p> or =0.157). Again, the differences were not significant. The sensitivity of the ECG for MI localization was highest in inferior infarctions (85.71%), the specificity was highest in anterior infarctions (100%), the best positive predictive value (80%) was achieved for anterolateral infarctions, and the best negative predictive value for lateral infarctions (95.83%). Transmural and non-transmural MI cannot be differentiated by ECG. The ECG is most accurate in detecting anterolateral MI.
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Meios de Contraste/farmacologia , Eletrocardiografia/normas , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Gadolínio DTPA/farmacologia , Humanos , Aumento da Imagem , Imageamento por Ressonância Magnética/métodosAssuntos
Procedimentos Cirúrgicos Cardíacos , Cardiomiopatia Hipertrófica , Septos Cardíacos , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/terapia , Etanol/administração & dosagem , Feminino , Gadolínio DTPA , Septos Cardíacos/efeitos dos fármacos , Septos Cardíacos/fisiopatologia , Humanos , Doença Iatrogênica , Aumento da Imagem , Imagem Cinética por Ressonância Magnética/métodos , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/fisiopatologiaAssuntos
Endocardite Bacteriana/diagnóstico , Imageamento por Ressonância Magnética/métodos , Insuficiência da Valva Mitral/diagnóstico , Infecções Estreptocócicas/diagnóstico , Idoso , Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Insuficiência da Valva Mitral/etiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Estreptococos Viridans/isolamento & purificaçãoAssuntos
Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Imageamento por Ressonância Magnética , Síndrome Pós-Pericardiotomia/complicações , Síndrome Pós-Pericardiotomia/diagnóstico por imagem , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Tamponamento Cardíaco/terapia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Eletrocardiografia , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/terapia , Pericardiocentese , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Síndrome Pós-Pericardiotomia/terapia , Intensificação de Imagem Radiográfica , Reoperação , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/cirurgiaAssuntos
Ablação por Cateter , Cicatriz/diagnóstico por imagem , Cicatriz/cirurgia , Doença Iatrogênica , Imageamento por Ressonância Magnética , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Gadolínio , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem RadiográficaRESUMO
In recent years, intravascular ultrasound (IVUS) has evolved as an important adjunct to angiography, providing insights that are significantly altering conventional paradigms in diagnosis and therapy. However, major drawbacks in the use of IVUS relied on the fact that a heavy console had to be moved from lab to lab, and extensive time for set up and image analysis. This additional time and the decrease in patients' through-put has not been applicable in clinical practice for many labs. Our manuscript concerns a novel PC-based platform for IVUS that enables the online intergration of digital intracoronary ultrasound images into angiographic images. This new technique offers remote operation, multiple control devices and custom viewing options. The PC-based platform enables IVUS images to be viewed simultaneously from multiple vantage points in the lab, and allows for multiple user interfaces.