Case 13.30

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0354 ◽

2014 ◽

pp. 671-672

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Chest Pain ◽

Right Ventricle ◽

Cervical Carcinoma ◽

Right Atrium ◽

Anterior Wall ◽

Proton Density ◽

Short Axis ◽

Free Wall ◽

Contrast Enhanced ◽

The Right

46-year-old woman receiving chemotherapy and radiotherapy for cervical carcinoma diagnosed 6 months ago; she now has new-onset chest pain Axial double (Figure 13.30.1) and triple (Figure 13.30.2) inversion recovery FSE images with proton density- and T2-weighting demonstrate a poorly defined mass involving the anterior wall of the right atrium and free wall of the right ventricle. Short-axis contrast-enhanced LGE images (...

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Case 13.23

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0347 ◽

2014 ◽

pp. 657-658

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Right Ventricle ◽

Elective Surgery ◽

Ventricular Septum ◽

Proton Density ◽

Short Axis ◽

Free Wall ◽

Male Adolescent ◽

Fatty Replacement ◽

P 16 ◽

The Right

16-year-old male adolescent with an arrhythmia during elective surgery Axial end-systolic SSFP images (Figure 13.23.1) demonstrate small focal outpouchings along the free wall of the right ventricle. Axial double inversion recovery proton density-weighted FSE image (Figure 13.23.2) reveals minimal fatty replacement in the right side of the ventricular septum. Short-axis MDE image (...

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The study of systemic hemodynamic disorders of patients with varicose and post-thrombotic diseases

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2020-19-2-32-37 ◽

2020 ◽

Vol 19 (2) ◽

pp. 32-37

Author(s):

I. N. Shanaev

Keyword(s):

Blood Flow ◽

Right Ventricle ◽

Right Atrium ◽

Ultrasound Examination ◽

Anterior Wall ◽

Right Heart ◽

Normal Limits ◽

Flow Through ◽

The Right ◽

Restrictive Type

Aim. Study of heart function in the patients with CVD. Materials and methods. 46 patients with varicosity (VD) and 34 patients with post-thrombotic disease (PTD) were examined; the control group was represented by 15 healthy volunteers. The diagnosis was established using the CEAP basic classification. The study did not include patients with a diagnosed arterial hypertension, diabetes mellitus, chronic lung disease, significant hemodynamic heart defects, coronary heart disease. Ultrasound examination of the heart and veins of the lower extremities was performed on a Saote My Lab Alpha, Acuson Sequoia 512 apparatus. In addition to the standard protocol of heart ultrasound examination, the parameters of the right heart were calculated: sizes of the right ventricle (RV), right atrium, thickness of the anterior wall of the pancreas; to assess the ejection fraction (EF) of the pancreas the mobility of the lateral edge of the tricuspid ring was calculated, and the pressure on the tricuspid valve (TV) was measured. Diastolic ventricular function was studied by spectrograms of tricuspid and mitral blood flow. Results. Most of the indicators of cardiac activity in patients with VD were within normal limits, but a tendency to increase increasing of the right heart size was noted. In addition, the thickness of the interventricular septum and the right ventricle (RV) anterior wall was found to increase from 0.8 to 1.1 cm and from 0.3 to 0.5 cm, respectively, according clinical classes from C2 to C6 (CEAP). Eject fraction (EF) of both the RV and the left ventricle (LV) were also within normal limits, but with a tendency to decrease (67.8 % – C2, to 62 % – C6). The growth of the clinical class is followed by the increasing of percentage of non-restrictive blood flow through the tricuspid valve (TV). The restrictive type of blood flow in patients with VD had not been identified. Patients with PTD also showed a tendency to increase the right heart. However, whereas the size of the RV, as a rule, did not exceed 3.0 cm, the size of the right atrium was slightly higher than normal one in the clinical class C4 and C5.6. All the patients had EF of LV within normal limits, but it slightly decreased by the growth of class. Only patient classes C3 and C4 had EF of RV within the normal range. The 18 % of patient class C5.6 had EF lower than normal with value 48%. Diastolic dysfunction (DD) of the RV was detected in 73.3% of patients with class C3 and 100% with classes C4 and C5.6. Moreover, a restrictive type of blood flow through TV appeared from class C4 and the percentage increased up to 27.2% (class C5,6). Conclusions. DD of the RV was the main hemodynamic disorder.

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Case 13.25

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0349 ◽

2014 ◽

pp. 661-662

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Chest Pain ◽

Right Ventricular ◽

Signal Intensity ◽

Ventricular Free Wall ◽

Proton Density ◽

Free Wall ◽

Shortness Of Breath ◽

Right Ventricular Free Wall ◽

History Of ◽

The Right

27-year-old man with a 3-month history of chest pain and mild shortness of breath Four-chamber SSFP image (Figure 13.25.1) demonstrates a large well-defined mass in the right ventricular free wall. Four-chamber double (Figure 13.25.2) and triple (Figure 13.25.3) inversion recovery FSE images with proton density- and T2-weighting reveal mildly decreased signal intensity relative to myocardium. Four-chamber MDE image (...

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Case 13.24

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0348 ◽

2014 ◽

pp. 659-660

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Right Ventricular ◽

Inversion Recovery ◽

Ventricular Free Wall ◽

Double Inversion Recovery ◽

Proton Density ◽

Short Axis ◽

Free Wall ◽

Right Ventricular Free Wall ◽

Right Ventricular Mass ◽

The Right

46-year-old man with a right ventricular mass detected incidentally on echocardiography A lobulated, well-defined mass in the right ventricular free wall demonstrates mild hyperintensity relative to myocardium on axial double inversion recovery proton density-weighted FSE (Figure 13.24.1) and short-axis SSFP (Figure ...

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Case 13.27

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0351 ◽

2014 ◽

pp. 665-666

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Right Ventricle ◽

Right Atrium ◽

Inversion Recovery ◽

Double Inversion Recovery ◽

Proton Density ◽

Atrioventricular Groove ◽

The Right

36-year-old woman with hemoptysis and abnormal findings on CT Axial proton density-weighted double inversion recovery FSE images (Figure 13.27.1) demonstrate a heterogeneous mass infiltrating the right atrium, the right atrioventricular groove, and the base of the right ventricle. Horizontal long-axis (Figure ...

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CMR markers for early right ventricular dysfunction in precapillary pulmonary hypertension

European Heart Journal ◽

10.1093/ehjci/ehaa946.0241 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Vos ◽

T Leiner ◽

A.P.J Van Dijk ◽

F.J Meijboom ◽

G.T Sieswerda ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricle ◽

Right Ventricular ◽

Circumferential Strain ◽

Peak Strain ◽

Healthy Controls ◽

Free Wall ◽

Global Circumferential Strain ◽

The Right ◽

Rv Function

Abstract Introduction Precapillary pulmonary hypertension (pPH) causes right ventricular (RV) pressure overload inducing RV remodeling, often resulting in dysfunction and dilatation, heart failure, and ultimately death. The ability of the right ventricle to adequately adapt to increased pressure loading is key for patients' prognosis. RV ejection fraction (RVEF) by cardiac magnetic resonance (CMR) is related to outcome in pPH patients, but this global measurement is not ideal for detecting early changes in RV function. Strain analysis on CMR using feature tracking (FT) software provides a more detailed assessment, and might therefore detect early changes in RV function. Aim 1) To compare RV strain parameters in pPH patients and healthy controls, and 2) to compare strain parameters in a subgroup of pPH patients with preserved RVEF (pRVEF) and healthy controls. Methods In this prospective study, a CMR was performed in pPH patients and healthy controls. Using FT-software on standard cine images, the following RV strain parameters were analyzed: global, septal, and free wall longitudinal strain (GLS, sept-LS, free wall-LS), time to peak strain (TTP, as a % of the whole cardiac cycle), the fractional area change (FAC), global circumferential strain (GCS), global longitudinal and global circumferential strain rate (GLSR and GCSR, respectively). A pRVEF is defined as a RVEF >50%. To compare RV strain parameters in pPH patients to healthy controls, the Mann-Whitney U test was used. Results 33 pPH-patients (55 [45–63] yrs; 10 (30%) male) and 22 healthy controls (40 [36–48] yrs; 15 (68%) male) were included. All RV strain parameters were significantly reduced in pPH patients compared to healthy controls (see table), except for GCS and GCSR. Most importantly, in pPH patients with pRVEF (n=8) GLS (−26.6% [−22.6 to −27.3] vs. −28.1% [−26.2 to −30.6], p=0.04), sept-LS (−21.2% [−19.8 to −23.2] vs. −26.0% [−24.0 to −27.9], p=0.005), and FAC (39% [35–44] vs. 44% [42–47], p=0.02) were still significantly impaired compared to healthy controls. The RV TTP was significantly increased in pPH patients compared to healthy controls (47% [44–57] vs. 40% [33–43], p≤0.001). Conclusions Several CMR-FT strain parameters of the right ventricle are impaired in pPH patients when compared to healthy controls. Moreover, even in pPH patients with a preserved RVEF multiple RV strain parameters (GLS, sept-LS, and FAC) remained significantly impaired, and TTP significantly prolonged, in comparison to healthy controls. This suggests that RV strain parameters may be used as an early marker of RV dysfunction in pPH patients. Funding Acknowledgement Type of funding source: None

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Evaluation of the morphology and mechanics of the right ventricle using echocardiography before and after transcatheter balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.130 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

KIRILL Malikov ◽

MARINA Kirichkova ◽

MARIA Simakova ◽

NARECK Marukyan ◽

OLGA Moiseeva

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Pulmonary Artery Pressure ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Reverse Remodeling ◽

Free Wall ◽

Artery Pressure ◽

Balloon Pulmonary Angioplasty ◽

Before And After ◽

The Right

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) leads to a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) with the development of severe dysfunction of the right heart and heart failure. Mortality for three years with an average pressure in the pulmonary artery (PA) of more than 50 mmHg is more than 90%. Balloon pulmonary angioplasty (BPA) has a significant advantage over other methods of surgical treatment, but it requires the determination of additional non-invasive markers of effectiveness. Transthoracic echocardiography (TTE) remains the main method for assessing the morphology and function of the heart. Purpose Compare different indicators reflecting the severity of CTEPH with TTE indicators before and after BPA. To evaluate the effectiveness of using BPA for the treatment of patients with CTEPH using routine TTE and speckle tracking mode. Materials and methods For 18 months 30 patients without concomitant cardiovascular pathology were subjected to several BPA sessions. Before treatment, 50% of patients belonged to the 3 CTEPH functional class (FC), 40% to 2 FC, 10% to 1 FC. The average number of sessions was 4.7 ± 1.3. Before the first BPA and after the last, all the patients were performed: six-minute walk test (6MWT, metres), Borg scale (in points), test for NT-proBNP (pg/ml); TTE with assessment of the right ventricle (RV) and left ventricle (LV) including areas of the right atrium (aRA, cm2), mean pulmonary artery pressure (PUPM,mmHg),RV free wall strain (GLSFW, %), RV free wall strain rate (GLSRFW, sm/sec), RV free wall postsystolic shortening (PSSFW, %), tricuspid annular plane systolic excursion (TAPSE, sm), tricuspid annulus systolic velocity (TASV, sm/sec). Results. Before the first BPA session, the 6MWT in the patient group averaged 315.9 ± 9.08 metres, after - 439.5 ± 11.45 m; the Borg from 5.4 ± 0.94 points decreased to 4 ± 1.01 points; NT-proBNP before the treatment was 1513 ± 13.01 pg/ml, after - 171 ± 6.09; according to TTE the ratio of RV/ LV before and after treatment was 1.31 ± 0.02 and 0.97 ± 0.04; aRA was 29.3 ± 4.87 and 22.3 ± 3.53 cm2; basal RV - 52 ± 5.11 and 44 ± 7.26 mm; PUPM decreased from 76.6 ± 7.65 to 31.3 ± 3.78 mmHg; GLSFW from -14.69 ± 2.33 came to 17.5 ± 3.45 %; GLSRFW with -0.9 ± 0.09 to -1.7 ± 0.11 cm/sec; TAPSE from 16.7 ± 1.87 to 18.2 ± 2.34 cm; TASV from 10.11 ± 1.45 to 12.25 ± 1.98 cm/s, PSSFW before treatment was -18.4 ± 1.2%, after treatment in 66% of patients disappeared, in 34% became an average of 17.4 ± 0.9% The distribution of STEPH FC has also changed. Conclusion. BPA leads to an improvement in the tolerance of physical activity, clinical indicators, and parameters of central hemodynamics in the pulmonary circulation, evaluated according to direct manometry, and leads to reverse remodeling of the RV in the long term. Performing a staged BPA leads to an improvement in the functional parameters of contractility of the RV.

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P686 Right atrial, right ventricular and pulmonary cement embolism: a rare complication of percutaneous vertebroplasty

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.362 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Akhunova ◽

R Khayrullin ◽

N Stekolshchikova ◽

M Samigullin ◽

V Padiryakov

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Right Atrium ◽

Percutaneous Vertebroplasty ◽

Rare Complication ◽

Clinical Manifestations ◽

Stable Condition ◽

Right Atrial ◽

Cement Embolism ◽

The Right

Abstract A 68-year-old man was admitted to the hospital with complaints of pain in the lumbar spine. He had L5 disc herniation, Spinal stenosis of the L5 root canal - S1 on the right in the past medical history. Percutaneous vertebroplasty at the level of L3 and Th8 vertebral bodies was performed six months ago due to painful vertebral hemangioma. The man is suffering from arterial hypertension, receives antihypertensive therapy. During routine transthoracic echocardiography, a hyperechoic structure with a size of 9.5 x 0.9 cm was found in the right atrium and right ventricle. Chest computed tomography with contrast enhancement revealed signs of bone cement in the right atrium and right ventricle, in the right upper lobe artery, in the branches of the upper lobe artery, in the paravertebral venous plexuses. Considering the duration of the disease, the stable condition, the absence of clinical manifestations and disorders of intracardiac hemodynamics, it was decided to refrain from surgical treatment. Antiplatelet therapy and dynamic observation were recommended. Conclusion Percutaneous vertebroplasty is a modern minimally invasive surgical procedure for the treatment of degenerative-dystrophic diseases of the spine. However, the cement can penetrate into the paravertebral veins and migrate to the right chambers of the heart and the pulmonary artery. This clinical case demonstrates asymptomatic cement embolism of the right chambers of the heart and pulmonary artery after percutaneous vertebroplasty, detected incidentally during routine echocardiography. Abstract P686 Figure.

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