Systemic thrombo-embolic events in a middle-aged male with Loeffler endocarditis without peripheral eosinophilia-a case report.

BACKGROUND: Loeffler-endocarditis (LE) is considered a chronic restrictive cardiomyopathy and manifestation of eosinophilic myocarditis characterized by eosinophilic infiltration. LE is a rare underdiagnosed disease and associated with high morbidity and mortality. CASE PRESENTATION: We report a case of a 46-year-old man suffering from LE associated with thromboembolic events without peripheral eosinophilia. The patient presented with typical clinical signs of acute onset of limb ischaemia, predominantly on the right limb, indicating immediate iliacal thrombectomy and due to a severe compartment syndrome additional fasciotomy. Total occlusion also of left popliteal artery suggesting an impaired chronic and aggravated impaired perfusion indicated also urgent left sided revascularization. Subsequent echocardiography revealed severe left ventricular dysfunction with a striking amount of spontaneous echo-contrast, noticeable in the left ventricular cavity. Furthermore the initial CT scan demonstrated asymptomatic left kidney- and brain infarctions. Diagnostic workup including endomyocardial biopsy (EMB) of the left ventricle, uncovered an underlying LE without peripheral eosinophilia. CONCLUSIONS: This case demonstrates and highlights the findings, treatment and outcome of a patient with LE and associated thrombo-embolic events without peripheral eosinophilia and emphazises the importance of awareness for LE in patients presenting with an acute cardiac decompensation and thrombo-embolic events. EMB should be performed early in unstable patients unsuitable for cardiovascular magnetic resonance imaging.

Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock.

BACKGROUND: Eosinophilic myocarditis (EM) is a rare form of myocarditis. Clinical presentation is various, includes cardiogenic shock and can often be fatal. Diagnosis is based on myocardial eosinophilic infiltration in endomyocardial biopsy. Mechanical circulatory support (MCS) is often required in patients suffering from severe cardiogenic shock. Among the available MCS options the "ECMELLA" concept, a combination of left ventricular venting by Impella® device and extracorporeal life support (ECLS) is possibly able to provide the necessary time frame for diagnostics and initiation of anti-inflammatory medication in patients with fulminant myocarditis. CASE PRESENTATION: We report a case of a 38-year-old woman who was presented to us in severe cardiogenic shock, quickly requiring hemodynamic support by an Impella CP® device. Further dramatic hemodynamic deterioration accompanied by multi-organ dysfunction required escalation of MCS via ECLS as veno-arterial extracorporeal membrane oxygenation (VA-ECMO). After histopathological diagnosis of EM, our patient was put on immunosuppressive therapy with prednisolone. Recovery of both right and left ventricular function allowed explanation of VA-ECMO on day 4 and further hemodynamic improvement allowed removal of the Impella® device on day 9. The patient was discharged after 7 weeks with fully restored cardiac function and in a good neurological state. CONCLUSIONS: In severe cardiac shock due to fulminant EM the ECMELLA concept as bridge-to-recovery seems to be a valid option to provide the required time for diagnostics and specific therapy.

Asymptomatic brain lesions following laserballoon-based pulmonary vein isolation.

AIMS: Laserballoon-based pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) has proven safe and effective. Silent brain lesions after AF ablation detected on magnetic resonance imaging (MRI) have been described for several technologies, but its incidence following laserballoon PVI is unknown. The current study sought to assess the incidence of new asymptomatic brain lesions in patients undergoing laserballoon-based PVI. METHODS AND RESULTS: Patients referred for PVI underwent pre- and post-procedural MRI of the brain. A total of 86 patients were enroled into the study (laserballoon group: 44 patients, 15 female, age 63 ± 9 years, left atrial (LA) diameter 43 ± 5 mm; cryoballoon group: 20 patients, 6 female, age 61 ± 9 years, LA diameter 41 ± 4 mm; and irrigated radiofrequency (RF) group: 22 patients, 11 female, age 64 ± 8 years, LA diameter 43 ± 6 mm). There was no statistically significant difference between the groups with regard to new asymptomatic brain lesions detected on post-procedural MRI: 5 of 44 (11.4%) patients in the laserballoon group, 1 of 20 (5.0%) patients in the cryoballoon group, and 4 of 22 (18.2%) patients in the irrigated RF group, respectively. In the laserballoon group, one additional patient with a new cerebral lesion experienced transient diplopia. In a multivariate regression model the only risk factor for asymptomatic new lesions was the CHA2DS2VASc score. CONCLUSION: Following laserballoon-based PVI, new asymptomatic brain lesions were detected in 11.4% of patients. A higher CHA2DS2VASc score, but not the ablation technology utilized, was the only associated risk factor.

Endovascular repair of ascending aortic aneurysm by transapical approach and periscope technique.

PURPOSE: To demonstrate transapical stent-graft implantation for the treatment of an ascending aortic aneurysm simultaneously using the "periscope" technique for all supra-aortic branches. TECHNIQUE: The treatment plan is demonstrated in a 67-year-old man with prior ascending aortic replacement and known ascending aortic aneurysm who presented with acute severe chest pain. Computed tomographic angiography (CTA) revealed an 11-cm ruptured aneurysm of the ascending aorta distal to the prosthesis. Surgery was impossible due to direct contact of the aneurysm with the sternum. Conventional retrograde stent-graft implantation was infeasible because of a sharp kink of the descending thoracic aorta, so the stent-grafts were implanted via a transapical approach. To provide blood flow to the supra-aortic branches, periscope grafts oriented from the target vessels down the descending thoracic aorta were implanted in all branches before main stent-graft placement. Completion angiography and subsequent CTA documented satisfactory retrograde perfusion of the supra-aortic branches via the periscope grafts. CONCLUSION: A dual approach in terms of transapical stent-graft implantation and the periscope technique for perfusion of the supra-aortic branches may be an option for the treatment of inoperable aneurysms of the ascending aorta.

Acute Lymphocytic Myocarditis in a Young Male Post-COVID-19.

Background: Lymphocytic myocarditis is a rare form of myocarditis, associated with a high mortality rate due to a high risk of sudden cardiac death. Lymphocytic myocarditis might present as a relevant extrapulmonary manifestation after coronavirus disease 2019 (COVID-19) infection. Case presentation. We report a case of a 26-year-old male with lymphocytic myocarditis, presenting with a 1-month history of increasing fatigue, palpitations, and shortness of breath. Eight weeks before, he was tested positive for SARS-CoV-2. He had received 2-dose schedule of the COVID-19 mRNA vaccine Comirnaty® (BioNTech/Pfizer) 6 months prior to his admission. Diagnostic work-up by echocardiography and cardiac magnetic resonance (CMR) imaging demonstrated a severely reduced left ventricular function and a strong midmyocardial late gadolinium enhancement (LGE). Histology and immunohistology of the endomyocardial biopsies revealed an acute lymphocytic myocarditis. Immunosuppressive therapy with a steroid taper in combination with azathioprine 300 mg/day was initiated. The patient was equipped with a LifeVest®. On day 17, a non-sustained ventricular tachycardia was documented. Follow-up CMR imaging after 3 months showed a slightly improved systolic left ventricular function, and a strong LGE was still detectable. Conclusions: The case highlights the significance of recognizing lymphocytic myocarditis correlated to COVID-19. It is important to be vigilant also of a later presentation of cardiomyopathy in patients diagnosed with COVID-19 due to high mortality without immediate support.

Impact of pulmonary vein anatomy assessed by cardiac magnetic resonance imaging on endoscopic pulmonary vein isolation in consecutive patients.

AIMS: Recently, the novel endoscopic ablation system (EAS) was introduced and proved its potential for successful pulmonary vein isolation (PVI) in patients suffering from paroxysmal atrial fibrillation (PAF). The current study will investigate the impact of pulmonary vein (PV) anatomy assessed by pre-interventional cardiac magnetic resonance imaging (CMRI) on endoscopic PVI. METHODS AND RESULTS: Fifty-one patients (23 females, age 57 ± 9 years) with a long history (5 ± 5 years) of drug-refractory PAF were included into our analysis. Cardiac magnetic resonance imaging was performed in all patients before ablation. Each CMRI was evaluated for the number of PVs, for separate or common insertion of ipsilateral PVs, for the PV diameter and PV shape (round vs. oval), for the level of first PV branching, and for the level of insertion of the right inferior PV (RIPV) into the left atrium (LA), respectively. Pulmonary vein isolation was performed using exclusively the novel EAS. The CMRI findings were correlated with the ablation results. A total of 195 PVs were identified and targeted. In 192 of 195 (98%) PVs successful isolation was achieved using the novel EAS irrespective of the PV diameter, the PV shape, the level of PV branching, or the type of insertion of the PV into the LA. There was no statistical significance when correlating the CMRI findings with acute isolation success of the respective PVs or the number of laser applications needed until PVI (P> 0.05). A low level of insertion of the RIPV into the LA was not associated with PVI failure or a higher number of laser applications (P> 0.05). CONCLUSIONS: The majority of PVs could have been targeted and successfully isolated using exclusively the novel EAS irrespective of their anatomy assessed by pre-interventional CMRI. Considering the economical impact of CMRI and its minor influence on ablation strategy, success, and safety it is not an essential pre-requisite for subsequent successful EAS-based PVI.

Coronary MR angiography using citrate-coated very small superparamagnetic iron oxide particles as blood-pool contrast agent: initial experience in humans.

PURPOSE: To evaluate very small superparamagnetic iron oxide particles (VSOP-C184) as blood-pool contrast agent for coronary MR angiography (CMRA) in humans. MATERIALS AND METHODS: Six healthy volunteers and 14 patients with suspected coronary artery disease underwent CMRA after administration of VSOP-C184 at the following doses: 20 µmol Fe/kg (4 patients), 40 µmol Fe/kg (5 patients), 45 µmol Fe/kg (6 healthy volunteers), and 60 µmol Fe/kg (5 patients). In healthy volunteers, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and vessel edge definition (VED) of contrast-enhanced CMRA were compared with non-contrast-enhanced CMRA. In patients, a per-segment intention-to-diagnose evaluation of contrast-enhanced CMRA for detection of significant coronary stenosis (≥50%) was performed. RESULTS: Three healthy volunteers (45 µmol Fe/kg VSOP-C184) and two patients (60 µmol Fe/kg VSOP-C184) had adverse events of mild or moderate intensity. VSOP-C184 significantly increased CNR (15.1 ± 4.6 versus 6.9 ± 1.9; P = 0.010), SNR (21.7 ± 5.3 versus 15.4 ± 1.6; P = 0.048), and VED (2.3 ± 0.6 versus 1.2 ± 0.2; P < 0.001) compared with non-contrast-enhanced CMRA. In patients, contrast-enhanced CMRA yielded sensitivity, specificity, and diagnostic accuracy for detection of significant coronary stenosis of 86.7%, 71.0%, 73.1%, respectively. CONCLUSION: CMRA using VSOP-C184 was feasible and yielded moderate diagnostic accuracy for detection of significant coronary stenosis within this proof-of-concept setting.

Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults--towards identification of myocardial inflammation.

OBJECTIVE: To assess active myocardial inflammation by cardiovascular magnetic resonance (CMR) and endomyocardial biopsy (EMB) amongst adult patients with dilated cardiomyopathy (DCM). METHODS: We evaluated 23 adults with chronic DCM, who had successfully undergone both CMR and EMB within 3.5 ± 2.6 days. EMB was considered the gold standard. CMR assessment of myocardial inflammation used the following parameters as recommended by the recently published "Lake Louise Criteria": global myocardial oedema, global relative enhancement (RE), and late gadolinium enhancement (LGE). According to "Lake Louise Criteria", myocardial inflammation was diagnosed if two or more of the three above-mentioned parameters were positive. RESULTS: Myocardial inflammation was confirmed by immunohistology in 12 patients (52.2%). Sensitivity, specificity, and diagnostic accuracy of CMR to detect immunohistologically confirmed myocardial inflammation were 75.0%, 72.7%, and 73.9%, respectively. Sensitivity, specificity, and diagnostic accuracy of the individual CMR parameters to detect myocardial inflammation were as follows: global myocardial oedema, 91.7%, 81.8%, and 87.0%, respectively; global RE, 58.3%, 63.6%, and 60.9%, respectively; LGE, 58.3%, 45.4%, and 52.2%, respectively. CONCLUSION: Global myocardial oedema was identified as a promising CMR parameter for assessment of myocardial inflammation in patients with DCM. In these patients, global myocardial oedema yielded superior diagnostic performance compared to "Lake Louise Criteria".

Prevalence and functional impact of lipomatous metaplasia in scar tissue following myocardial infarction evaluated by MRI.

OBJECTIVE: To retrospectively assess the prevalence and functional relevance of lipomatous metaplasia (LM) of the left ventricle in patients with chronic ischaemic heart disease (CIHD) using cardiac magnetic resonance imaging (cMRI) with steady state free precession (SSFP) sequences. METHODS: We examined 315 patients (248 male, mean age 63 +/- 10 years) with a history of CIHD by cMRI. Standard SSFP sequences were applied and results were correlated with findings from cardiac catheterisation and computed tomography. In a subgroup of patients with LM (LM+) the functional results were correlated with patients without LM (LM-) as controls matched for age, body mass index, gender and infarct size. RESULTS: Of 315 patients, 36 showed LM. LM+ patients showed a higher tendency to develop aneurysms compared with LM- (31% vs. 17%; not significant), but no differences in ejection fraction or volumetric parameters. LM occurred significantly more often in older infarcts and patients with hyperlipoproteinaemia, while other cardiac risk factors or medication did not have a significant influence on the development of LM. CONCLUSIONS: LM is a common finding (11%) in patients with CIHD. LM does not have a significant influence on global cardiac function or ventricular size, but on local function and probably also on the development of left ventricular aneurysms.

Cardiac Arrest and Successful Extracorporeal Cardiopulmonary Resuscitation as a Result of a Refeeding Syndrome in a Young Female with Anorexia Nervosa.

Anorexia nervosa is a potentially life-threatening eating disorder, characterized by an abnormally low body weight. This case report illustrates a 22-year old female with cardiac arrest due to a refeeding syndrome in a patient with anorexia nervosa. It features the successful use of extracorporeal cardiopulmonary resuscitation in a case of severe left ventricular dysfunction resulting in a favorable outcome. Conclusion. We present the first case of a cardiac arrest due to a refeeding syndrome in anorexia nervosa featuring the successful use of an extracorporeal cardiopulmonary resuscitation approach as a bridge to full recovery.

Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial.

BACKGROUND: Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus. METHODS AND RESULTS: Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus abciximab administration with subsequent 12-hour intravenous infusion. The primary end point was infarct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance. Secondary end points were ST-segment resolution at 90 minutes, Thrombolysis in Myocardial Infarction flow and perfusion grades after PCI, and the occurrence of major adverse cardiac events within 30 days. The median infarct size was 15.1% (interquartile range, 6.1% to 25.2%) in the intracoronary versus 23.4% (interquartile range, 13.6% to 33.2%) in the intravenous group (P=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients (P=0.01). Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8% (interquartile range, 66.7% to 100.0%) versus 70.0% (interquartile range, 45.2% to 83.5%; P=0.006). The Thrombolysis in Myocardial Infarction flow after PCI was not different between treatment groups (P=0.51), but there was a trend toward an improved perfusion grade (P=0.09). There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application (5.2% versus 15.6%; P=0.06; relative risk, 0.33; 95% CI, 0.09 to 1.05). CONCLUSIONS: Intracoronary bolus administration of abciximab in primary PCI is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion.

Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging.

AIMS: The apical ballooning syndrome (ABS) is a new diagnostic entity which is increasingly recognized. Precise magnetic resonance imaging (MRI) data are not yet available and there is little evidence for the differential diagnosis of ABS assessed by MRI. METHODS AND RESULTS: Between January 2005 and January 2008, 6100 consecutive patients with diagnosis of acute coronary syndrome underwent left heart catheterization. In 59 patients (1.0%), coronary angiography revealed normal coronary arteries, but left ventriculography showed left ventricular dysfunction with apical ballooning. These 59 patients underwent cardiac MRI using a 1.5 T MRI scanner. In 13 patients (22.0%), MRI revealed diagnosis of myocardial infarction, in eight patients (13.6%) diagnosis of myocarditis. In all other 38 (64.4%) patients (36 female, age 73 +/- 10 years) with suspected ABS, no delayed enhancement or signs of inflammation were detected. Follow-up MRI after 3 months showed a completely normalized left ventricular ejection in all patients with suspected ABS. Similarly, the end-diastolic volume and end-systolic volume improved at follow-up. CONCLUSION: Cardiac MRI allows differentiating ABS from other rare causes with unobstructed coronary vessels such as myocarditis and coronary emboli with spontaneous lysis. Therefore, cardiac MRI can add valuable information in all patients with suspected ABS for further differential diagnosis.

Diagnostic Value of the Magnetic Resonance Imaging With Intratympanic Gadolinium Administration (IT-Gd MRI) Versus Audio-Vestibular Tests in Menière's Disease: IT-Gd MRI Makes the Difference.

OBJECTIVE: Our aim was to evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). The focus was on: three-dimensional fluid-attenuated inversion recovery-SPectral Attenuated Inversion Recovery (3D-FLAIR-SPAIR) sequences using 3 Tesla magnetic resonance imaging (3T MRI) performed 24 hours after intratympanic Gadolinium injection (IT-Gd) in comparison with the functional tests pure tone audiometry (PTA), caloric test, video head impulse test (vHIT), and cervical-vestibular-evoked-myogenic-potentials (cVEMP). STUDY DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: Primary eligibility criteria were given clinical suspicion of MD and the performance of an IT-Gd MRI leading to a group of 31 patients and 52 ears to be analyzed separately. MAIN OUTCOME MEASURE (S): Reanalysis of the raw diagnostic data leading to comparability of IT-Gd MRI, PTA, caloric test, vHIT, and cVEMP concerning their valency for clinically diagnosed MD and quantifiability of EH. RESULTS: Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH. CONCLUSIONS: It appears that the diagnosing process of MD would benefit from turning IT-Gd MRI into a standard diagnostic procedure in cases of suspected MD, displaying better results than caloric test, vHIT, and cVEMP.

Assessment of late gadolinium enhancement in nonischemic cardiomyopathy: comparison of a fast Phase-Sensitive Inversion Recovery Sequence (PSIR) and a conventional segmented 2D gradient echo recall (GRE) sequence--preliminary findings.

BACKGROUND: Reliable detection of myocardial scarring in nonischemic cardiomyopathy is time-consuming using techniques that require determination of optimal inversion time. Therefore we evaluated an inversion-time-insensitive approach using a fast phase-sensitive inversion recovery (PSIR) sequence to detect and quantify late gadolinium enhancement (LGE). PATIENTS AND METHODS: Twenty patients (mean age 40 years, 9 females) with nonischemic cardiomyopathy and evidence of LGE were evaluated. After administration of 0.2 mmol/kg gadolinium diethylene triamine pentaacetic acid, a segmented 2D inversion recovery turbo fast low-angle shot gradient echo recall (GRE) sequence [echo time (TE) 4.3 milliseconds, repetition time (TR) 750 milliseconds, alpha 30 degrees , voxel size 1.7 x 1.3 x 8-10 mm] was obtained and served as the standard of reference. Second, a fast multislice single-shot 2D PSIR sequence (TE 1.1 millisecond, TR 700 milliseconds, alpha 40 degrees , voxel size 2.5 x 1.7 x 8-10 mm) was acquired in the same slice positions. The PSIR(IR) images were used to analyze LGE. Altogether 53 short-axis slices with LGE were evaluated. Contrast-to-noise ratio and area of LGE were calculated and compared by 2 experienced readers. Image quality and confidence level for identification of LGE were rated on 5-point scales. Interobserver variability was evaluated in 10 patients. RESULTS: All images were interpretable. Imaging time was reduced from 385 +/- 127 seconds to 20 +/- 3 seconds (P < 0.001). Contrast-to-noise ratio was 8.29 for PSIRmag and 12.07 for the conventional GRE images (P < 0.001). The mean area of LGE was 1.01 +/- 0.62 cm(2) for the GRE sequence and 1.10 +/- 0.62 cm(2) for PSIR(IR) (P = NS). The general linear model showed no interaction between the results and no significant difference of the mean (r = 0.09, mean difference 0.09 cm(2)). The overall interobserver variability of PSIR(IR) and GRE was excellent, with Pearson's correlation coefficients of r = 0.96 for PSIR(IR) and r = 0.98 for GRE. PSIR(IR) and conventional GRE were comparable in terms of image quality and confidence level (image quality: 1.6 +/- 0.67 vs. 1.5 +/- 0.93, P = NS; confidence level: 1.4 +/- 0.84 vs. 1.3 +/- 0.5; P = NS). CONCLUSIONS: Fast PSIR sequences enable accurate detection and quantification of LGE in nonischemic cardiomyopathies. The examination time can be significantly shortened using the single-shot approach of the PSIR technique.

First-in-Man Analysis of the Relationship Between Electrical Rotors From Noninvasive Panoramic Mapping and Atrial Fibrosis From Magnetic Resonance Imaging in Patients With Persistent Atrial Fibrillation.

BACKGROUND: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of atrial fibrosis. The novel noninvasive epicardial and endocardial electrophysiology system (NEEES) allows for the identification of sources with rotor activity. This study describes a new technique to examine the relationship between rotors and LGE signal intensity in patients with persistent atrial fibrillation (PERS) scheduled for ablation. METHODS AND RESULTS: Ten consecutive patients underwent pulmonary vein isolation for persistent atrial fibrillation. LGE CMR of both atria was performed, and NEEES-based analysis was conducted to identify rotors. For each mapping point, the intracardiac locations were transferred onto an individual CMR-derived 3-dimensional shell. This allowed the LGE signal intensity to be projected onto the anatomy from the NEEES analysis. NEEES analysis identified a total number of 410 electric rotors, 47.8% were located in the left atrium and 52.2% in the right atrium. Magnetic resonance imaging analysis was performed from 10 right atria and 10 left atria data sets, including 86 axial LGE CMR planes per atrium. The mean LGE burden for left atrium and right atrium was 23.9±1.6% and 15.9±1.8%, respectively. Statistical analysis demonstrated a lack of regional association between the extent of LGE signal intensity and the presence of rotors. CONCLUSIONS: This is the first study demonstrating that the presence of rotors based on NEEES analysis is not directly associated with the extent and anatomic location of LGE signal intensity from CMR. Further studies evaluating the relationship between rotors and fibrosis in patients with persistent atrial fibrillation are mandatory and may inform strategies to improve ablation outcome.

Contrast enhancement in electron beam tomography of the heart: comparison of a monomeric and a dimeric iodinated contrast agent in 59 patients.

RATIONALE AND OBJECTIVES: The aim of the study is to determine whether intravascular time-density course and visualization of the coronary arteries differ with use of a hyperosmolar monomeric versus an iso-osmolar dimeric contrast agent in electron beam tomography (EBT) of the heart. MATERIALS AND METHODS: Fifty-nine patients underwent EBT of the coronary arteries using the monomeric ioversol or the dimeric iodixanol at the same concentration of 320 mg I/mL. Contrast volume was determined relative to body surface area and injected over 40 seconds. Intravascular time-density curves were created for quantitative analysis. For qualitative assessment, visualization of coronary arteries on axial scans and three-dimensional reconstructions was scored. Patients were matched for contrast flow, transit time, and mean pulse rate for statistical analysis. RESULTS: Ioversol produced a significantly greater increase in intravascular density for up to 30 seconds after injection (P < .01) compared with iodixanol. No difference between the two contrast media was seen in the qualitative assessment. CONCLUSION: Monomeric and dimeric contrast media differ in their time-density curves at coronary EBT, a reason for which is not apparent. Qualitative evaluation of coronary arteries is not affected by this difference.

Corrective Operation in an Intramyocardial Dissecting Hemorrhage After Subacute Anterior Myocardial Infarction.

Intramyocardial dissecting hemorrhage is a very rare and potentially lethal complication of myocardial infarction. The diagnosis is typically made by echocardiography, by cardiac magnetic resonance imaging, at operation, or during postmortem examination. Medical treatment is most often associated with high mortality, and surgical treatment is required. We report a 53-year old man admitted to the urology department with a large left-sided kidney infarction. A subacute myocardial infarction by electrocardiogram, elevated troponin T level, and typical clinical signs of an acute coronary syndrome 5 days and 2 weeks before admission were also evident. Intramyocardial dissecting hemorrhage with an adjacent thrombotic formation was suspected by echocardiography and cardiac computed tomography and confirmed by magnetic resonance imaging. The patient underwent successful surgical correction and was discharged in good clinical condition.

A vascular stent as an active component for locally enhanced magnetic resonance imaging: initial in vivo imaging results after catheter-guided placement in rabbits.

RATIONALE AND OBJECTIVE: A vascular stent constructed as a high frequency resonator improves the local signal-to-noise ratio at magnetic resonance (MR) imaging. After catheter placement and intravascular expansion, the stent can be used as an inductively coupled coil for MRI. The imaging properties of this balloon-expandable active MRI stent (AMRIS) were evaluated after x-ray fluoroscopy guided placement in the abdominal aorta of five rabbits using MR angiography (MRA) and flow measurements. METHODS: The AMRIS was implanted in the abdominal aorta of five rabbits using a balloon catheter inserted through the common carotid artery. The rabbits were examined by MRA (3D fast low-angle shot) at 1.5 tesla before and after intravenous injection of an iron-oxide-based blood pool contrast medium (dose 50 micro mol Fe/kg) and flow measurements (ECG-triggered phase contrast cine gradient-echo sequence). Signal-to-noise ratios (SNR) were calculated and flow volume curves were generated. The in-stent increase in temperature was measured in vitro using a fiberoptic thermometry system. RESULTS: The SNR was 5.0 +/- 0.6 outside the stent and 23.2 +/- 14.1 within the stent ( < 0.0 5) in plain MRA, 19.5 +/- 5.0 outside and 30.7 +/- 8.2 within the stent ( < 0.05) in contrast enhanced MRA, and 5.8 +/- 1.6 and 13.9 +/- 5.9, respectively ( < 0.05) in the magnitude images of the flow measurements. Flow volume curves within and distal to the stent were comparable. CONCLUSIONS: The expandable active MRI stent produces local signal enhancement in MRA and MR flow measurements after catheter placement and thus may improve assessment of the stented vessel segment by MR imaging.