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1.
Int Heart J ; 62(2): 329-336, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731518

RESUMO

The reasons of residual left ventricular outflow tract (LVOT) obstruction following alcohol septal ablation (ASA) remain unclear, and outcomes of myectomy following failed ASA remain underreported.Thirteen symptomatic patients (10 women, a median age of 60.0 years) who underwent septal myectomy following failed ASA were reviewed. The patients were followed up for a median of 6 months. The clinical characteristics and outcomes of these patients were analyzed and were compared with those of 178 patients who underwent isolated myectomy without previous ASA at our institution during the same period.In the first ASA procedure, the median number of septal perforator arteries injected was 1.0 with the median value of peak creatine kinase following ablation of 978.5 U/L.Uncontrollable extent and location of infarcted myocardium caused by ablation and mitral subvalvular anomalies were found in four (30.8%) and seven (53.8%) patients, respectively. No operative or follow-up deaths occurred. The median maximum LVOT gradients fell from preoperative 112.0 to 8.5 mmHg at follow-up (P < 0.001). Compared with controls, patients with failed ASA had a higher proportion of mitral subvalvular anomalies (53.8% versus 13.5%, P = 0.001) and developed a higher incidence of complete atrioventricular block following myectomy (15.4% versus 1.7%, P = 0.038).Low institutional or operator experience with ablation, uncontrollable extent and location of infarcted myocardium caused by ablation, and mitral subvalvular anomalies may be reasons for failed ASA. Surgical myectomy for the treatment of residual LVOT obstruction after unsuccessful ASA may be associated with favorable results.


Assuntos
Técnicas de Ablação/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Etanol/farmacologia , Septos Cardíacos/cirurgia , Obstrução do Fluxo Ventricular Externo/terapia , Adulto , Idoso , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/fisiopatologia
4.
Radiol Med ; 125(11): 1056-1071, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32946001

RESUMO

Cardiomyopathies are a heterogeneous entity. The progress in the field of genetics has allowed over the years to determine its origin more and more often. The classification of these pathologies has changed over the years; it has been updated with new knowledge. Imaging allows to define the phenotypic characteristics of the different forms of cardiomyopathy. Cardiac magnetic resonance (CMR) allows a morphological evaluation of the associated (and sometimes pathognomonic) cardiac findings of any form of cardiomyopathy. The tissue characterization sequences also make magnetic resonance imaging unique in its ability to detect changes in myocardial tissue. This review aims to define the features that can be highlighted by CMR in hypertrophic and dilated forms and the possible differential diagnoses. In hypertrophic forms, CMR provides: precise evaluation of wall thickness in all segments, ventricular function and size and evaluation of possible presence of areas of fibrosis as well as changes in myocardial tissue (measurement of T1 mapping and extracellular volume values). In dilated forms, cardiac resonance is the gold standard in the assessment of ventricular volumes. CMR highlights also the potential alterations of the myocardial tissue.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Cardiomiopatia Dilatada/genética , Cardiomiopatia Hipertrófica/genética , Meios de Contraste , Diagnóstico Diferencial , Feminino , Gadolínio , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/patologia , Humanos , Hipertrofia/diagnóstico por imagem , Hipertrofia/patologia , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade
5.
J Cardiovasc Magn Reson ; 22(1): 66, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32921308

RESUMO

BACKGROUND: Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) is a valuable technique for detecting myocardial disorders and fibrosis. However, we sometimes observe a linear, mid-wall high intensity signal in the basal septum in the short axis view, which often presents diagnostic difficulties in the clinical setting. The purpose of this study was to compare the linear, mid-wall high intensity in the basal septum identified by LGE with the anterior septal perforator arteries identified by coronary computed tomography angiography (CorCTA). METHODS: We retrospectively selected 148 patients who underwent both CorCTA and CMR LGE within 1 year. In the interpretation of LGE, we defined a positive linear high intensity (LHI+) as follows: ① LHI in the basal septum and ② observable for 1.5 cm or more. All other patients were defined as a negative LHI (LHI-). In LHI+ patients, we assessed the correlation between the LHI length and the septal perforator artery length on CorCTA. We also compared the length of the septal perforator artery on CorCTA between LHI+ patients and LHI- patients. RESULTS: A population of 111 patients were used for further analysis. Among these , there were 55 LHI+ patients and 56 LHI- patients. In LHI+ patients, linear regression analysis revealed that there was a good agreement between LGE LHI and septal perforator arteries by CorCTA in terms of length measurements. The measured length of the anterior septal perforator arteries was significantly shorter in LHI- patients than in LHI+ patients (10 ± 8 mm vs. 21 ± 8 mm; P < 0.05). CONCLUSIONS: The LHI observed in the basal septum on short axis LGE may reflect contrast enhancement of the anterior septal perforator arteries. It is important to interpret this septal LHI against knowledge of anatomic structure, to avoid misinterpretations of LGE and prevent misdiagnosis.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste/administração & dosagem , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Gadolínio DTPA/administração & dosagem , Septos Cardíacos/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Isquemia Miocárdica/diagnóstico por imagem , Idoso , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
J Card Surg ; 35(10): 2863-2865, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720392

RESUMO

BACKGROUND: Cardiac myxomas are common and account for 50% of primary intracardiac tumors. Atypical locations of cardiac myxoma increase the risk of intraoperative iatrogenic injuries. Herein, we report a case of using three-dimensional printing (3D) to facilitate the removal of an atypical cardiac myxoma in a 63-year-old woman. METHODS AND RESULTS: Mass in the high posterior atrial septum was confirmed through imaging. Due to the potential involvement of the mass to surrounding vital structures, 3D printing of the cardiac mass was performed. The tumor was completely resected via median sternotomy and the resulting defect was repaired with the bovine pericardium. The patient had an uncomplicated postoperative course except for the development of sick sinus syndrome. One-year follow-up showed no tumor recurrent. CONCLUSION: 3D printing technology in patients with atypical cardiac tumors enhances our understanding of the extent of the tumor invasion and facilitates planning the operation to avoid intraoperative complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Doença Iatrogênica/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Modelos Anatômicos , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Impressão Tridimensional , Animais , Bioprótese , Bovinos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/patologia , Invasividade Neoplásica , Pericárdio/transplante , Esternotomia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Cardiovasc Diabetol ; 19(1): 64, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404127

RESUMO

BACKGROUND: Type 2 diabetes mellitus is common in cardiovascular disease. It is associated with adverse clinical outcomes for patients who had undergone coronary artery bypass and valve operations. The aim of this study was to evaluate the impact of type 2 diabetes mellitus on the midterm outcomes of patients with hypertrophic cardiomyopathy who underwent septal myectomy. METHODS: We retrospectively analyzed the data of 67 hypertrophic cardiomyopathy patients with type 2 diabetes mellitus who underwent septal myectomy from two medical centers in China from 2011 to 2018. A propensity score-matched cohort of 134 patients without type 2 diabetes mellitus was also analyzed. RESULTS: During a median follow-up of 28.0 (interquartile range: 13.0-3.0) months, 9 patients died. The cause of death of all of these patients was cardiovascular, particularly sudden cardiac death in 3 patients. Patients with type 2 diabetes mellitus had a higher rate of sudden cardiac death (4.5% vs. 0.0%, p = 0.04). The Kaplan-Meier survival analysis revealed that the rates of predicted 3-year survival free from cardiovascular death (98.1% vs. 95.1%, p = 0.14) were similar between the two groups. However, the rates of predicted 3-year survival free from sudden cardiac death (100% vs. 96.7%, p = 0.01) were significantly higher in hypertrophic cardiomyopathy patients without type 2 diabetes mellitus than in those with type 2 diabetes mellitus. Furthermore, after adjustment for age and sex, only N-terminal pro-brain natriuretic peptide (hazards ratio: 1.002, 95% confidence interval: 1.000-1.005, p = 0.02) and glomerular filtration rate ≤ 80 ml/min (hazards ratio: 3.23, 95% confidence interval: 1.34-7.24, p = 0.047) were independent risk factors for hypertrophic cardiomyopathy patients with type 2 diabetes mellitus. CONCLUSIONS: Hypertrophic cardiomyopathy patients with and without type 2 diabetes mellitus have similar 3-year cardiovascular mortality after septal myectomy. However, type 2 diabetes mellitus is associated with higher sudden cardiac death rate in these patients. In addition, N-terminal pro-brain natriuretic peptide and glomerular filtration rate ≤ 80 ml/min were independent risk factors among hypertrophic cardiomyopathy patients with type 2 diabetes mellitus.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiomiopatia Hipertrófica/cirurgia , Morte Súbita Cardíaca/epidemiologia , Diabetes Mellitus Tipo 2/mortalidade , Septos Cardíacos/cirurgia , Adulto , Pequim/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/mortalidade , Cardiomiopatia Hipertrófica/fisiopatologia , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Int J Cardiovasc Imaging ; 36(6): 1041-1050, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32056088

RESUMO

New-onset left bundle branch block (LBBB) is a frequent complication after transcatheter aortic valve replacement (TAVR) and provides an opportunity to study dyssynchrony immediately following acute LBBB. This study aims to (1) assess echocardiographic dyssynchrony in acute TAVR-induced LBBB (TAVR-LBBB), and (2) compare dyssynchrony parameters among different patient groups with LBBB. The study enrolled all TAVR-LBBB patients at Ghent University Hospital between 2013 and 2019. First, acute TAVR-LBBB dyssynchrony was assessed by: (1) septal flash (SF); (2) interventricular mechanical delay (IVMD; cut-off ≥ 40 ms) and (3) presence of 'classical dyssynchronous strain pattern' assessed with speckle tracking. Secondly, acute TAVR-LBBB patients with SF (LBBBTAVR+SF) were compared to randomly selected LBBB-SF patients with preserved (LBBBSF+PEF) ànd reduced ejection fraction (LBBBSF+REF). In TAVR-LBBB patients (n = 25), SF was detected in 72% of patients, whereas only 5% of TAVR-LBBB patients showed a classical dyssynchronous strain pattern. IVMD in these TAVR-LBBB patients was 39 ms. In 90% of LBBBTAVR+SF patients, SF was observed within 24 h after LBBB onset. Among LBBB-SF patients, a classical strain pattern was more prevalent in LBBBSF+REF patients compared to LBBBTAVR+SF patients (80% vs. 7%; p < 0.001). IVMD was significantly longer in LBBBSF+PEF patients (52 ms; p = 0.002) and LBBBSF+REF patients (57 ms; p = 0.009) compared to LBBBTAVR+SF patients (37 ms). SF is an early and prevalent marker of LV dyssynchrony in acute TAVR-LBBB, whereas strain-based measures and IVMD do not appear to capture dyssynchrony at this early stage. Our findings from the comparative analysis generate the hypothesis that progressive LBBB-induced LV remodeling may be required for a 'classical dyssynchrony strain pattern' or significant IVMD to occur in TAVR-LBBB patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/diagnóstico , Ecocardiografia , Eletrocardiografia , Septos Cardíacos/diagnóstico por imagem , Volume Sistólico , Substituição da Valva Aórtica Transcateter/efeitos adversos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Bélgica/epidemiologia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Feminino , Septos Cardíacos/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia , Remodelação Ventricular
12.
Interact Cardiovasc Thorac Surg ; 30(2): 303-311, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31642911

RESUMO

OBJECTIVES: The aim of this study was to establish an original transapical septal myectomy procedure that can be performed in the beating heart via a minimally invasive approach for the treatment of hypertrophic obstructive cardiomyopathy. METHODS: We designed an original intracardiac septum resection device to conduct off-pump septal myectomy in swine. A subxiphoid minithoracotomy was performed to access the apex of the heart. This resection device was inserted into the left ventricular outflow tract of the heart via the apex. The basal anteroseptal myocardium beneath the right aortic cusp was identified using a combination of transoesophageal and transthoracic echocardiography and then resected and collected by the device. RESULTS: Six consecutive operations were successfully and accurately performed using the custom-made device under echocardiographic guidance. All pigs survived and appeared to be normal until planned euthanasia 1 week after operation. A 300-700 mg portion of the septal myocardium was resected from the normal swine heart. Echocardiography and electrocardiogram revealed no abnormalities after resection. One exception was the fifth pig, in which mild annular regurgitation of the aortic valve occurred after repetitive resection. Postmortem necropsy demonstrated that all resections were correctly located at the basal anteroseptal septum beneath the right aortic cusp. CONCLUSIONS: Our study provides the first proof-of-concept evidence for a novel beating heart transapical septal myectomy procedure, which showed promising translational potential for the treatment of hypertrophic obstructive cardiomyopathy. This procedure would probably reduce operative risks and improve outcomes and reduce the demanding expertise required to perform conventional surgical myectomy.


Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Contração Miocárdica/fisiologia , Animais , Cardiomiopatia Hipertrófica/fisiopatologia , Modelos Animais de Doenças , Ecocardiografia , Estudos de Viabilidade , Feminino , Septos Cardíacos/diagnóstico por imagem , Masculino , Suínos , Resultado do Tratamento
13.
Catheter Cardiovasc Interv ; 95(4): 830-837, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31410979

RESUMO

OBJECTIVE: To describe the hemodynamic and early clinical outcomes of percutaneous alcohol septal ablation in patients with concomitant dynamic left ventricular outflow tract (LVOT) obstruction and aortic valvular stenosis (AS). BACKGROUND: Alcohol septal ablation is an established method to relieve dynamic LVOT obstruction in patients with hypertrophic cardiomyopathy (HCM). However, the feasibility, safety, and efficacy of alcohol septal ablation in patients with serial obstructions from HCM and AS remain unclear. METHODS: In this case series, we describe the early outcomes of alcohol septal ablation in six patients with significant dynamic LVOT obstruction and AS. All patients had evidence of severe dynamic LVOT obstruction (resting or provoked gradient ≥50 mmHg), mild to severe AS, and NYHA class III symptoms or greater. RESULTS: Four (66.7%) patients had septal ablation performed in the setting of concomitant native valvular AS and two (33.3%) patients had TAVR performed prior to septal ablation. Successful alcohol septal ablation was performed in all patients and was associated with an immediate reduction of the dynamic LVOT gradient with a residual fixed obstruction related to AS. Four (66.7%) patients had follow-up at 1 month and of these, three (75%) had NYHA Class I-II symptoms and one (25%) Class III. CONCLUSIONS: Alcohol septal ablation is a feasible method of relieving dynamic LVOT obstruction in patients with concomitant HCM and AS. Further study is required to determine the optimal treatment approach in these patients.


Assuntos
Técnicas de Ablação , Estenose da Valva Aórtica/complicações , Cardiomiopatia Hipertrófica/cirurgia , Etanol/administração & dosagem , Septos Cardíacos/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Técnicas de Ablação/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Etanol/efeitos adversos , Estudos de Viabilidade , Feminino , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
14.
Trends Cardiovasc Med ; 30(2): 115-122, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31000325

RESUMO

Cardiac resynchronization therapy (CRT) has been a major step in the treatment of heart failure patients and intraventricular conduction delay. As a considerable number of patients do not respond adequately to CRT, echocardiographic dyssynchrony selection criteria have been proposed to improve CRT response, but these parameters eventually failed to provide superior selection of CRT candidates. In the last decade, an echo-dyssynchrony parameter called "septal flash" was been reported by several investigators and opinion leaders in the field of CRT. This parameter has a strong pathophysiological rationale and was shown to be a robust and predominant predictor of CRT response in recent observational and retrospective studies. We here provide a comprehensive and balanced overview of septal flash and address several important aspects, questions and potential future implications of septal flash in cardiomyopathy and CRT.


Assuntos
Bloqueio de Ramo/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Septos Cardíacos/fisiopatologia , Disfunção Ventricular Esquerda/terapia , Função Ventricular Esquerda , Potenciais de Ação , Animais , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Tomada de Decisão Clínica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Septos Cardíacos/diagnóstico por imagem , Humanos , Recuperação de Função Fisiológica , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Remodelação Ventricular
15.
Clin Res Cardiol ; 109(2): 205-214, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31236691

RESUMO

BACKGROUND: Subclinical atrial fibrillation (AF) is the underlying cause in a relevant part of patients with embolic stroke of unknown source (ESUS). This pilot study aims to identify novel echocardiographic parameters predicting AF subsequently detected in patients originally hospitalized with ESUS. METHODS AND RESULTS: Patients with acute ischemic stroke [baseline diagnosis of ESUS (n = 69), stroke of macro- or microvascular cause (n = 16/25), stroke caused by AF (n = 5)] and controls with paroxysmal AF without acute ischemic stroke (n = 22) as well as healthy controls of young and old age (n = 21/17) in sinus rhythm were included (overall n = 175). Echocardiography was performed in all participants. Prolonged Holter-ECG-monitoring was performed in all stroke patients. In the overall cohort, septal total atrial conduction time (sPA-TDI), left atrial (LA) volume index to tissue Doppler velocity (LAVI/a`) and second negative peak strain rate during LA contraction (SRa), representing echocardiographic parameters of LA remodelling and function, were statistically significant different in patients with and without AF and predictive for subclinical AF (multivariate regression analysis: sPA-TDI: HR 1.06 [1.04-1.08], p < 0.001; LAVI/a`: HR 0.85, [0.74-0.97], p = 0.02; SRa: HR 2.35 [0.9-5.5], p = 0.05). Multivariate Cox regression analysis revealed sPA-TDI as an independent predictor of AF in ESUS patients (sPA-TDI: HR 1.10 [1.04-1.17], p = 0.001). A sPA-TDI of 126 ms strictly discriminated between presence and absence of subclinical AF within 48 h after initiation of Holter-ECG-monitoring in ESUS patients. CONCLUSIONS: sPA-TDI seems to be a strong independent predictor of subclinical AF in patients hospitalized for ESUS and might support risk-stratified clinical decision making in these patients. Septal Total Atrial Conduction Time (sPA-TDI) determined by echocardiography for prediction of Atrial Fibrillation in Embolic Stroke of Unknown Source (ESUS).


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Isquemia Encefálica/etiologia , Ecocardiografia Doppler , Frequência Cardíaca , Septos Cardíacos/diagnóstico por imagem , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Potenciais de Ação , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Remodelamento Atrial , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Estudos de Casos e Controles , Eletrocardiografia Ambulatorial , Feminino , Fibrose , Septos Cardíacos/fisiopatologia , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
17.
J Cardiovasc Electrophysiol ; 30(12): 2950-2959, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31661178

RESUMO

BACKGROUND: Optical coherence tomography (OCT) has the potential to provide real-time imaging guidance for atrial fibrillation ablation, with promising results for lesion monitoring. OCT can also offer high-resolution imaging of tissue composition, but there is insufficient cardiac OCT data to inform the use of OCT to reveal important tissue architecture of the human left atrium. Thus, the objective of this study was to define OCT imaging data throughout the human left atrium, focusing on the distribution of adipose tissue and fiber orientation as seen from the endocardium. METHODS AND RESULTS: Human hearts (n = 7) were acquired for imaging the left atrium with OCT. A spectral-domain OCT system with 1325 nm center wavelength, 6.5 µm axial resolution, 15 µm lateral resolution, and a maximum imaging depth of 2.51 mm in the air was used. Large-scale OCT image maps of human left atrial tissue were developed, with adipose thickness and fiber orientation extracted from the imaging data. OCT imaging showed scattered distributions of adipose tissue around the septal and pulmonary vein regions, up to a depth of about 0.43 mm from the endocardial surface. The total volume of adipose tissue detected by OCT over one left atrium ranged from 1.42 to 28.74 mm3 . Limited fiber orientation information primarily around the pulmonary veins and the septum could be identified. CONCLUSION: OCT imaging could provide adjunctive information on the distribution of subendocardial adipose tissue, particularly around thin areas around the pulmonary veins and septal regions. Variations in OCT-detected tissue composition could potentially assist ablation guidance.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Endocárdio/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Miócitos Cardíacos/patologia , Tomografia de Coerência Óptica , Idoso , Endocárdio/patologia , Feminino , Átrios do Coração/patologia , Septos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Veias Pulmonares/diagnóstico por imagem
18.
J Cardiovasc Electrophysiol ; 30(12): 2841-2848, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31596023

RESUMO

The aim of the study was to provide quantitative data and to look for new landmarks useful during transseptal puncture (TSP) using a fluoroscopy-guided approach. METHODS AND RESULTS: A total of 104 patients at mean age 57 ± 12 years, of whom 92% underwent pulmonary vein isolation, were analysed. Before TSP catheters were placed in the coronary sinus (CS) and His bundle region. A guidewire running from femoral vein through great veins was left loose in superior vena cava. Before TSP X-ray images were taken in right anterior oblique (RAO) 45° and RAO 53° projections. Locations posterior to TSP site in RAO were described with negative values and those anterior with positive values. The measured distances in millimeters were as follows: (a) between TSP site and posterior atrial wall (RAO 45 = -21 ± 7 mm; RAO 53 = -19 ± 6 mm (b) between TSP site and free guidewire (RAO 45 = -5 ± 4 mm, RAO 53 = -3 ± 4 mm (c) between TSP site and CS ostium (RAO 45 = 9 ± 6 mm; RAO 53 = 8 ± 5 mm (d) between TSP site and His region (RAO 45 = 29 ± 8 mm; RAO 53 = 30 ± 8 mm). We observed correlations between measured distances and age, body mass index and sizes of cardiac chambers. The distance between TSP site and the line projected by the guidewire running between great veins, measured in mid-RAO projections, was very small. CONCLUSION: The distances between TSP site and standard anatomical landmarks used during TSP vary with regard to age, physique and cardiac chamber dimensions. TSP site, as assessed in mid RAO, is in direct vicinity to the line projected by a guidewire running between the great veins.


Assuntos
Pontos de Referência Anatômicos , Fibrilação Atrial/diagnóstico por imagem , Cateterismo Cardíaco , Cateterismo Periférico , Veia Femoral/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter , Cateterismo Periférico/efeitos adversos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Punções , Adulto Jovem
19.
Med Ultrason ; 21(3): 279-287, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476208

RESUMO

AIM: To establish reference range values for peak myocardial tissue Doppler velocity (MTD) and myocardial performance index (MPI) of the left ventricle (LV), the right ventricle (RV), and the interventricular septum (IVS) at 20 to 36+6 weeks of gestation using spectral tissue Doppler. MATERIAL AND METHODS: This cross-sectional study was conducted among 360 lowrisk singleton pregnancies. MTD during systole (S'), and early (E') and late diastole (A'), and MPI' were assessed by placing sample volume at the basal segment of the LV free wall, the RV free wall, and the IVS, respectively. Polynomial regression was used to obtain the best-fit curves for MTD and MPI' measurements as a function of gestational age (GA), and adjustments were made using the determination coefficient (R2). Intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC). RESULTS: All MTD velocities (cm/s) progressively increased with advancing GA (p<0.0001). Mean LV MTD values were 4.19 to 6.86 for S', 3.52 to 7.22 for E', and 6.85 to 9.19 for A'; mean RV MTD were 4.85 to 7.97 for S', 4.49 to 8.66 for E', and 8.44 to 11.20 for A'; and mean IVS MTD values were 3.75 to 5.78 for S', 3.34 to 5.79 for E', and 5.88 to 7.98 for A'. LV MPI', RV MPI', and IVS MPI' did not significantly change with advancing GA. The CCC values for MTD were predominantly greater than 0.70, while those for MPI' were <0.70. CONCLUSIONS: Reference values for the fetal MTD and MPI' of RV, LV and IVS using tissue Doppler between 20 and 36+6 weeks of gestation were described.


Assuntos
Ecocardiografia Doppler/métodos , Coração Fetal/fisiologia , Septos Cardíacos/fisiologia , Ultrassonografia Pré-Natal/métodos , Função Ventricular/fisiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Coração Fetal/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Ventrículos do Coração , Humanos , Variações Dependentes do Observador , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
20.
J Obstet Gynaecol Res ; 45(11): 2150-2157, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31441198

RESUMO

AIM: To evaluate the level of agreement between M-mode and pulsed-wave tissue Doppler imaging (PW-TDI) techniques in assessing fetal mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE) and septal annular plane systolic excursion (SAPSE) in a low-risk population. METHODS: This prospective longitudinal study included healthy fetuses assessed from 18 to 40 weeks of gestation. Tricuspid annular plane systolic excursion, MAPSE and SAPSE were measured using anatomical M-mode and PW-TDI. The agreement between the two diagnostic tests was assessed using Bland-Altman analysis. RESULTS: Fifty fetuses were included in the final analysis. Mean values of TASPE were higher than that of MAPSE. There was a progressive increase of TAPSE, MAPSE and SAPSE values with advancing gestation. For each parameter assessed, there was an overall good agreement between the measurements obtained with M-mode and PW-TDI techniques. However, the measurements made with M-mode were slightly higher than those obtained with PW-TDI (mean differences: 0.03, 0.05 and 0.03 cm for TAPSE, MAPSE and SAPSE, respectively). When stratifying the analyses by gestational age, the mean values of TAPSE, MAPSE and SAPSE measured with M-Mode were higher compared to those obtained with PW-TDI, although the mean differences between the two techniques tended to narrow with increasing gestation. Tricuspid annular plane systolic excursion, MAPSE and SAPSE measurements were all significantly, positively associated with gestational age (all P < 0.001). CONCLUSION: Fetal atrioventricular annular plane displacement can be assessed with M-mode technique, or with PW-TDI as the velocity-time integral of the myocardial systolic waveform. Atrioventricular annular plane displacement values obtained with M-mode technique are slightly higher than those obtained with PW-TDI.


Assuntos
Ecocardiografia Doppler de Pulso/estatística & dados numéricos , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Ecocardiografia Doppler de Pulso/métodos , Feminino , Coração Fetal/embriologia , Coração Fetal/fisiologia , Idade Gestacional , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/embriologia , Humanos , Estudos Longitudinais , Valva Mitral/diagnóstico por imagem , Valva Mitral/embriologia , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Sístole , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/embriologia , Ultrassonografia Pré-Natal/métodos
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