3D Assessment of myocardial perfusion parameter combined with 3D reconstructed coronary artery tree from digital coronary angiogramsSchindler, T.H.; Magosaki, N.; Jeserich, M.; Nitzsche, E.; Oser, U.; Abdollahnia, T.; Nageleisen, M.; Zehender, M.; Just, H.; Solzbach, U.
doi: 10.1023/A:1006216221695pmid: 10832619
In patients with coronary artery disease coronary angiography plays an important role in the clinical decision-making process. However, it has been recognized that no simple relation exists between the visually or quantitatively evaluated severity of coronary artery stenoses and its effects on regional myocardial perfusion. This paper describes for the first time the development and application of a 3D technique that visualizes and quantifies regional myocardial perfusion parameters from biplane coronary angiograms by using the impulse response analysis technique. The 3D reconstructed coronary tree is automatically superimposed on the 3D perfusion image to generate and visualize an ‘integrated’ 3D image. The preliminary results in patients with critical coronary artery stenoses indicate that our combined 3D fusion image provides flow information from the major coronary arteries. This 3D fusion image may provide useful information in the management of patients with coronary artery disease.
Computerized left ventricular pressure–volume relationships (pV-loops) using disposable angiographic tip transducer pigtail cathetersRaff, Ulrich; Culclasure, Talley; Clark, Cathy; Overturf, Lana; Groves, Bertron
doi: 10.1023/A:1006349123217pmid: 10832620
Left ventricular pressure–volume relationships expressed as pV loops could yield important hemodynamic information in the cardiac catheterization laboratory. Many clinical situations might benefit from a quantitative assessment of left ventricular function. Potential applications of pV loops include the assessment of vasoactive and inotropic drugs, balloon valvuloplasty, coronary angioplasty, and surgical treatment of valvular heart disease. For many years the clinical use of pV loops has been hindered by logistical difficulties. The ability to merge on-line concurrent digital imaging data for computation of left ventricular volume and digital left ventricular pressure wave forms obtained from high fidelity tip-transducer angiocatheters has allowed us to develop a technique which can generate pV loops during cardiac catheterization procedures. The method offers an automated measurement of left ventricular volume independent of edge detection or an interactive technique for tracing endocardial borders by a trained operator. Illustrative case studies are included to demonstrate the potential of the method during ventricular angiographic procedures. Implementation and computational time requirements of the method are discussed. The concept and the value of pV loop generation to study left ventricular performance has been known for many years. Combining digital imaging and digital physiologic data obtained with disposable tip-transducer angiocatheters with modern networking technology, the technique can more easily be applied to catheterization procedures and could enhance invasive hemodynamic assessment of left ventricular function.
Mechanical properties and imaging characteristics of remanufactured intravascular ultrasound cathetersHoffmann, Rainer; Haager, Phillip; Mintz, Gary; Klues, Heinz
doi: 10.1023/A:1006310612175pmid: 10832621
Intravascular ultrasound (IVUS) as a routine device in interventional cardiology is handicapped by its high price. 19 factory-made, ‘remanufactured’ IVUS catheters which consist of sterilized, used phased-array IVUS transducers inserted into a new catheter shaft were compared with 23 new IVUS catheters. 3 mechanical and 4 imaging characteristics were assessed on a 5 point scale (1 = unacceptable, 5 = excellent). Mechanical as well as imaging properties of ‘remanufactured’ IVUS catheter were comparable to new catheters with excellent ratings for each of the evaluated characteristics in 38 to 94% of ‘remanufactured’ catheters and 50 to 96% of new catheters. The initial failure rate for ‘remanufactured’ IVUS catheters was 31.6% vs. 4.3% for new catheters (P < 0.05). Overall failure rate was 47.3% for “remanufactured” catheters vs. 8.7% for new catheters (P < 0.05). The failure was due to an electronic connecting problem occurring during mechanical stress to the IVUS catheter. In conclusion, ‘remanufactured’ IVUS catheters offer mechanical and imaging characteristics which are comparable to new catheters. Improvements in the ‘remanufacturing’ process to resolve the high rate of electronic connecting problems may make this a promising approach to substantially lower the price of IVUS catheters.
Echocardiographic evaluation of left ventricular function in pure mitral stenosisMittal, S.R.; Goozar, Rajendar
doi: 10.1023/A:1006341200771pmid: 10832622
Echocardiographic evaluation of left ventricular function was performed in 22 cases of pure rheumatic mitral stenosis and 22 age matched normal persons. Cases with any evidence of rheumatic activity in the preceding six months, those with gross tricuspid regurgitation and paradoxical movement of the interventricular septum and cases with atrial fibrillation were excluded. None of the patients showed systolic left ventricular dysfunction. Left ventricular end diastolic dimension was also not affected. Echocardiographic parameters did not have any relation for mitral valve area. Our observations show that mitral stenosis per se does not affect left ventricular function.
Imaging of an aneurysm of the sinus of Valsalva with transesophageal echocardiography, contrast angiography and MRIBaur, Leo; Vliegen, Hubert; van der Wall, Ernst; Hazekamp, Mark; Bootsma, Marianne; de Roos, Albert; Bruschke, Albert
doi: 10.1023/A:1006389116701pmid: 10832623
A sinus of Valsalva aneurysm is an uncommon congenital defect, which requires appropriate diagnosis with either echocardiography, magnetic resonance imaging or contrast angiography. Treatment consists of aortic valve repair. We describe a young woman with an aneurysm of the non-coronary sinus of Valsalva, an atrial septal defect and pulmonary insufficiency. The different imaging techniques and possibilities of surgical correction are described.
Reduced early diastolic inflow velocities in the antero-posterior transverse direction in the left ventricle of patients with dilated cardiomyopathyFujimoto, Shinichi; Nakagawa, Yoshihito; Mizuno, Reiko; Nakanishi, Shiro; Dohi, Kazuhiro
doi: 10.1023/A:1006315127220pmid: 10832624
In patients with dilated cardiomyopathy (DCM), the left ventricular (LV) inflow jet is narrow and has a high pressure gradient. A pulsed Doppler restrictive transmitral flow pattern is a characteristic feature of severe left ventricular disease. However, Doppler flow analysis is limited by the angle between the blood flow jet and the ultrasonic beam. In this study we used gated magnetic resonance imaging (MRI) to investigate the inflow velocity in the LV transverse directions during early diastole in patients with DCM. Methods: We studied 10 patients with DCM (mean age: 47 y). Ten age-matched healthy volunteers were also examined. Gradient echo images of the LV were obtained. Left ventricular short axis phase contrast images were obtained at the level of the mitral valve tip and 1 cm inside the LV. Long axis images were also obtained. Through-plane peak velocities at peak early diastolic filling were measured along the LV long axis, antero-posterior short axis, and right-left short axis. Blood velocity was measured in 50 ms blocks. Results: Early diastolic inflow velocity along the long axis, especially at the center of the LV, was well preserved in DCM. However, the inflow velocity in the antero-posterior transverse direction of the LV (i.e., in the direction of mitral valve excursion) was significantly reduced in DCM. Conclusions: Early diastolic inflow velocity in the antero-posterior transverse direction of the LV is reduced in patients with DCM indicating that the vector component of the forces acting in the antero-posterior transverse direction of the LV may be decreased in patients with DCM during early diastolic filling.
Chylous ascites due to constrictive pericarditisGüneri, Sema; Nazli, Cem; Kinay, Ozan; Kirimli, Onder; Mermut, Cem; Hazan, Eyüp
doi: 10.1023/A:1006379625554pmid: 10832625
Chylous ascites due to constrictive pericarditis is an extremely rare clinical entity, possibly caused by the augmented lymph production and high impedance to lymph drainage due to central venous hypertension. The authors describe a patient with chylous ascites caused by constrictive pericarditis in the absence of lymphatic obstruction. Cardiac catheterization is essential for the confirmation of accurate diagnosis of constrictive pericarditis. Magnetic resonance imaging of the heart is also very helpful in the diagnosis. The patient was symptom free and his ascites and edema completely resolved after pericardiectomy.