An Asymptomatic Needle in the Left Ventricular Anterolateral Wall: A Prison Inmate's Strange Radio Antenna

Abstract Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging. Case summary We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1 month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11 years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11 years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened global LV function. Discussion Peripartum cardiomyopathy may have different clinical presentations. Attentive clinical evaluation and multimodality imaging can provide precise diagnostic and prognostic information.

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Abstract 17756: Do Biventricular Mechanics in Transient Constrictive Pericarditis Improve After Medical Therapy?

Circulation ◽

10.1161/circ.130.suppl_2.17756 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ayman I Ayache ◽

Kenya Kusunose ◽

Hussain A Ismaeel ◽

Muhammad Tariq ◽

Deborah H Kwon ◽

...

Keyword(s):

Constrictive Pericarditis ◽

Myocardial Strain ◽

Strain Improvement ◽

Left Ventricular ◽

Systolic Strain ◽

Myocardial Mechanics ◽

Anterolateral Wall ◽

Anti Inflammatory ◽

Myocardial Strain Imaging

Introduction: Reversible constrictive pericarditis (CP) has been described with resolution of constriction after treatment with anti-inflammatory medications. In our study, we assessed the improvement of biventricular myocardial strain in CP patients treated medically compared to CP patients who underwent pericardiectomy. Methods and Results: We compared myocardial mechanics by 2-dimensional speckle tracking in 16 CP patients (age: 56±13; 75% males) who received anti-inflammatory medications to an age and sex matched CP group (age: 57±12; 75% males) who underwent pericardiectomy. At baseline, both treatment groups had depressed left ventricular (LV) anterolateral wall strain (LWS) and right ventricular (RV) free wall longitudinal systolic strain (FWS) but preserved LV septal wall systolic strain (SWS). In a median follow-up of 150 days the medically treated patients showed improvement of the depressed LVLWS/LVSWS (Pre: 0.61±0.17, Post: 0.89±0.21;P<0.001) and a trend in RVFWS/LVSWS (Pre:0.66±0.45, Post:0.89±0.38;P=0.12), that is similar to the improvement of the depressed LVLWS/LVSWS (Pre: 0.85±0.12, Post: 0.92±0.1;P<0.05) and trend in RVFWS/LVSWS (Pre: 0.77±0.32, Post: 0.86±0.18;P=0.09) of post pericardiectomy patients at a median follow-up of 74 days. Conclusions: Biventricular myocardial strain imaging is a robust technique for assessment of response to anti-inflammatory therapy in CP patients. Medical treatment of CP leads to systolic strain improvement that is more pronounced in the LV and RV free walls, hence having similar impact on the biventricular myocardial mechanics as pericardiectomy.

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External Reshaping of the Left Ventricle in Off-Pump Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.imi.0000220943.58491.df ◽

2006 ◽

Vol 1 (4) ◽

pp. 155-159

Author(s):

Sotirios N. Prapas ◽

Demetrios A. Protogeros ◽

Vassilios N. Kotsis ◽

Ioannis A. Panagiotopoulos ◽

Ioannis P. Raptis ◽

...

Keyword(s):

Coronary Artery ◽

Ejection Fraction ◽

Heart Surgery ◽

Bypass Graft ◽

Lateral Wall ◽

Left Ventricular ◽

Inferior Wall ◽

Off Pump ◽

Anterolateral Wall

Background Dyskinetic areas of the lateral and inferior left ventricular (LV) wall are frequently encountered in patients with coronary artery disease. In clinical practice, all of the techniques described for the restoration of shape and function of the LV require cardiopulmonary bypass. A new technique of LV external reshaping that aims to obtain a near-normal ventricular conical shape is described. This technique is performed during an off-pump coronary artery bypass graft (CABG) operation. It is used mainly on the inferior and lateral walls of the ventricle, but also on the anterolateral wall when warranted. This technique can be considered an alternative to classic aneurysmectomy in high-risk cases. Methods All patients underwent total arterial revascularization without aortic manipulation. Intraoperative transesophageal echocardiography was used in all cases to define the dilated akinetic/dyskinetic area. This area was effectively plicated using interrupted mattress sutures reinforced with Teflon felt or pericardial strips. This technique allows near normalization of the geometry of the ventricle and LV end-diastolic volume reduction. In cases of preexisting mitral regurgitation (MR), a reduction of the MR was observed after lateral wall restoration. From September 2002 to April 2005, the external reshaping technique was applied on 56 cases among 949 off-pump CABG cases (5.9%). A detailed transthoracic echocardiogram was obtained preoperatively. The mean ejection fraction of all enrolled patients was 31.2 ± 7%. The location of the plication was: lateral wall in 22, inferior wall in 16, and anterolateral wall in 18. The average number of coronary anastomoses was 2.6. Twelve patients were found to have 2–3 + MR. All patients were followed up during a period of 35 months. Results One patient died due to severe right ventricular dysfunction. Seven patients developed atrial fibrillation, and one had ventricular tachycardia. During the follow-up period, we observed a reduction of left ventricular end-diastolic diameter and a parallel augmentation of ejection fraction (mean 42.2 ± 4%). The ventricular cavity's architecture was normalized. Among the 12 patients with MR, an improvement of regurgitation was noted in 10 (from 2–3+ to 1–2+). One patient died during the follow-up period, and 1 patient required reoperation due to persistent severe MR. Conclusions The external reshaping of the LV during beating heart surgery is technically feasible, has promising results, and can be performed without major complications.

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Esophageal echocardiographic left ventricular anterolateral wall motion in normal subjects and patients with coronary artery disease.

Circulation ◽

10.1161/01.cir.63.5.1085 ◽

1981 ◽

Vol 63 (5) ◽

pp. 1085-1092 ◽

Cited By ~ 28

Author(s):

M Matsuzaki ◽

Y Matsuda ◽

Y Ikee ◽

Y Takahashi ◽

T Sasaki ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Wall Motion ◽

Normal Subjects ◽

Left Ventricular ◽

Anterolateral Wall ◽

Artery Disease

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Improvement in pump function with endocardial biventricular pacing increases with activation time at the left ventricular pacing site in failing canine hearts

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00295.2011 ◽

2011 ◽

Vol 301 (4) ◽

pp. H1447-H1455 ◽

Cited By ~ 9

Author(s):

Elliot J. Howard ◽

James W. Covell ◽

Lawrence J. Mulligan ◽

Andrew D. McCulloch ◽

Jeffrey H. Omens ◽

...

Keyword(s):

Heart Failure ◽

Biventricular Pacing ◽

Pressure Change ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Activation Time ◽

Lead Placement ◽

Anterolateral Wall ◽

The Right ◽

Transmural Function

Recently, attention has been focused on comparing left ventricular (LV) endocardial (ENDO) with epicardial (EPI) pacing for cardiac resynchronization therapy. However, the effects of ENDO and EPI lead placement at multiple sites have not been studied in failing hearts. We hypothesized that differences in the improvement of ventricular function due to ENDO vs. EPI pacing in dyssynchronous (DYSS) heart failure may depend on the position of the LV lead in relation to the original activation pattern. In six nonfailing and six failing dogs, electrical DYSS was created by atrioventricular sequential pacing of the right ventricular apex. ENDO was compared with EPI biventricular pacing at five LV sites. In failing hearts, increases in the maximum rate of LV pressure change (dP/d t; r = 0.64), ejection fraction ( r = 0.49), and minimum dP/d t ( r = 0.51), relative to DYSS, were positively correlated ( P < 0.01) with activation time at the LV pacing site during ENDO but not EPI pacing. ENDO pacing at sites with longer activation delays led to greater improvements in hemodynamic parameters and was associated with an overall reduction in electrical DYSS compared with EPI pacing ( P < 0.05). These findings were qualitatively similar for nonfailing hearts. Improvement in hemodynamic function increased with activation time at the LV pacing site during ENDO but not EPI pacing. At the anterolateral wall, end-systolic transmural function was greater with local ENDO compared with EPI pacing. ENDO pacing and intrinsic activation delay may have important implications for management of DYSS heart failure.

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Mitochondria in Cardiomyopathy: Alterations in Size, Number and Internal Structures

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100100378 ◽

1968 ◽

Vol 26 ◽

pp. 126-127

Author(s):

George Hug ◽

William K. Schubert

Keyword(s):

Heart Failure ◽

Biochemical Analysis ◽

Left Ventricular ◽

Size Number ◽

Internal Structures ◽

Left Ventricular Outflow ◽

Chest X Ray ◽

Myocardial Fibers ◽

Muscle Biopsies ◽

Needle Liver Biopsy

A white boy six months of age was hospitalized with respiratory distress and congestive heart failure. Control of the heart failure was achieved but marked cardiomegaly, moderate hepatomegaly, and minimal muscular weakness persisted.At birth a chest x-ray had been taken because of rapid breathing and jaundice and showed the heart to be of normal size. Clinical studies included: EKG which showed biventricular hypertrophy, needle liver biopsy which showed toxic hepatitis, and cardiac catheterization which showed no obstruction to left ventricular outflow. Liver and muscle biopsies revealed no biochemical or histological evidence of type II glycogexiosis (Pompe's disease). At thoracotomy, 14 milligrams of left ventricular muscle were removed. Total phosphorylase activity in the biopsy specimen was normal by biochemical analysis as was the degree of phosphorylase activation. By light microscopy, vacuoles and fine granules were seen in practically all myocardial fibers. The fibers were not hypertrophic. The endocardium was not thickened excluding endocardial fibroelastosis. Based on these findings, the diagnosis of idiopathic non-obstructive cardiomyopathy was made.

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Intracellular EDEMA does not adversely affect the ability to cryopreserve intact hearts

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100147235 ◽

1993 ◽

Vol 51 ◽

pp. 278-279

Author(s):

CL Hastings ◽

RD Carlton ◽

FG Lightfoot ◽

AF Tryka

Keyword(s):

Cell Injury ◽

Median Sternotomy ◽

Left Ventricular ◽

Ventricular Free Wall ◽

Hypoxic Cell ◽

Free Wall ◽

Sprague Dawley ◽

Left Ventricular Free Wall ◽

Sprague Dawley Rats

The earliest ultrastructural manifestation of hypoxic cell injury is the presence of intracellular edema. Does this intracellular edema affect the ability to cryopreserve intact myocardium? To answer this guestion, a model for anoxia induced intracellular edema (IE) was designed based on clinical intraoperative myocardial preservation protocol. The aortas of 250 gm male Sprague-Dawley rats were cannulated and a retrograde flush of Plegisol at 8°C was infused over 90 sec. The hearts were excised and placed in a 28°C bath of Lactated Ringers for 1 h. The left ventricular free wall was then sliced and the myocardium was slam frozen. Control rats (C) were anesthetized, the hearts approached by median sternotomy, and the left ventricular free wall frozen in situ immediately after slicing. The slam frozen samples were obtained utilizing the DDK PS1000, which was precooled to -185°C in liguid nitrogen. The tissue was in contact with the metal mirror for a dwell time of 20 sec, and stored in liguid nitrogen until freeze dry processing (Lightfoot, 1990).

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Ultrastructural observations of the aorta of calves implanted with a mechanical left ventricular assist device

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100161734 ◽

1990 ◽

Vol 48 (3) ◽

pp. 834-835

Author(s):

J P Cassella ◽

V Salih ◽

T R Graham

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Aortic Tissue ◽

Assist Device ◽

Ventricular Assist ◽

Transmission Electron ◽

Left Ventricular Assist ◽

Preliminary Study

Left ventricular assist systems are being developed for eventual long term or permanent implantation as an alternative to heart transplantation in patients unsuitable for or denied the transplant option. Evaluation of the effects of these devices upon normal physiology is required. A preliminary study was conducted to evaluate the morphology of aortic tissue from calves implanted with a pneumatic Left Ventricular Assist device-LVAD. Two 3 month old heifer calves (calf 1 and calf 2) were electively explanted after 128 days and 47 days respectively. Descending thoracic aortic tissue from both animals was removed immediately post mortem and placed into karnovsky’s fixative. The tissue was subsequently processed for transmission electron microscopy (TEM). Some aortic tissue was fixed in neutral buffered formalin and processed for routine light microscopy.

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Left Ventricular Hypertrophy

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2014.marapr04 ◽

2014 ◽

Vol 19 (2) ◽

pp. 11-15

Author(s):

Steven L. Demeter

Keyword(s):

Risk Factors ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Left Ventricular Mass Index ◽

Medical Science ◽

Careful Analysis ◽

Left Ventricular ◽

Hypertensive Disease ◽

Accurate Analysis ◽

Clear Explanation

Abstract The fourth, fifth, and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) use left ventricular hypertrophy (LVH) as a variable to determine impairment caused by hypertensive disease. The issue of LVH, as assessed echocardiographically, is a prime example of medical science being at odds with legal jurisprudence. Some legislatures have allowed any cause of LVH in a hypertensive individual to be an allowed manifestation of hypertensive changes. This situation has arisen because a physician can never say that no component of LVH was not caused by the hypertension, even in an individual with a cardiomyopathy or valvular disorder. This article recommends that evaluators consider three points: if the cause of the LVH is hypertension, is the examinee at maximum medical improvement; is the LVH caused by hypertension or another factor; and, if apportionment is allowed, then a careful analysis of the risk factors for other disorders associated with LVH is necessary. The left ventricular mass index should be present in the echocardiogram report and can guide the interpretation of the alleged LVH; if not present, it should be requested because it facilitates a more accurate analysis. Further, if the cause of the LVH is more likely independent of the hypertension, then careful reasoning and an explanation should be included in the impairment report. If hypertension is only a partial cause, a reasoned analysis and clear explanation of the apportionment are required.

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