Transplantation or Alternative Surgical Treatment of Patients with Ischemic Dilative Cardiomyopathy and Aneurysmatic Dilation of the Left Ventricular Cavity

2002 ◽  
Vol 25 (4) ◽  
pp. 321-326 ◽  
Author(s):  
Z. Mitrev ◽  
T. Anguseva ◽  
A. Vasileva ◽  
N. Hristov ◽  
P. Risteski
Keyword(s):  
Heart Disease ◽  
Spherical Geometry ◽  
Ultrastructural Level ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Organ Donors ◽  
Hemodynamic Parameters ◽  
Dilative Cardiomyopathy ◽  
Hemodynamic Improvement

Background Patients with terminal ischemic heart disease (IHD), severely depressed pump function with large LV dyskinesis with or without fibrosis do not benefit from revascularization alone; in time they are listed for transplantation. The long waiting list and lack of organ donors have imposed implementation of Direct Circular Repair (DCR) with total revascularization as an alternative. Methods DCR was performed on 17 patients with terminal IHD, after total revascularisation. The resected dyskinetic tissue was pathohistologicaly examined. Transesophageal ultrasound was performed pre- and early post-operatively and hemodynamic parameters measured invasively. Results Pathohistology showed that even in macroscopically viable myocardium where only dyskinesia without fibrosis persists, there are irreversible lesions on the ultrastructural level. Along with revascularization, with the application of DCR the LV spherical geometry was reconstructed with hemodynamic improvement. Conclusion Total revascularisation with DCR offers an alternative to transplantation in patients with wide anterior wall dyskinesia with or without fibrosis due to terminal IHD, the most frequent group listed for transplantation.

Vergleich von Belastungs- EKG und Radionuklid- Ventrikulographie bezüglich des Nachweises einer Myokardischämie bei isolierten Stenosen des Ramus interventricularis anterior

1988 ◽  
Vol 27 (02) ◽  
pp. 57-62
Author(s):  
R. Standke ◽  
R. P. Baum ◽  
S. Tezak ◽  
D. Mildenberger ◽  
F. D. Maul ◽  
...  
Keyword(s):  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Myocardial Ischemia ◽  
Ejection Fraction ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Global Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Exercise Ecg

21 patients with LAD-stenoses of at least 70% and 21 patients with LAD- stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81 % of all patients without infarction and in 71 % of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81 %, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2 (11 %) in the corresponding group with intramural infarction. The global ejection fraction was pathological in 1 (5%) healthy subject without infarction and in 3 (17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently.

scholarly journals Observation of Clinical Efficacy of Parylene-Coated Occluder Based on Electronic Image of Visual Sensor in the Treatment of Congenital Heart Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Hongdu Fu ◽  
Liming Liang ◽  
Huangwei Zhuang ◽  
Jiahui Yang
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Clinical Efficacy ◽  
Congenital Heart ◽  
Left Ventricular ◽  
System Level ◽  
Left Ventricular Cavity ◽  
Two Dimensional ◽  
Target Structure ◽  
Visual Sensor

With the acceleration of people’s life rhythm, the incidence of congenital heart disease is getting higher and higher. This study mainly explores the clinical efficacy observation of parylene-coated occluders based on the electronic image of the visual sensor in the treatment of congenital heart disease. The patient takes a supine position and observes whether the target structure (left ventricular cavity) information is separated from the capture area during rotation, and the angle of the probe is adjusted to ensure that as much target structure information as possible can be obtained during the two-dimensional image acquisition. During the three-dimensional ultrasound sampling process, a total of 60 coaxial images were collected within the range of 180°. To reflect the effect of virtual reality, it is necessary to provide users with interactive operation tools. This research provides two methods, mouse interaction and keyboard interaction. Through these two methods, the effect of the basic virtual endoscope is realized. Xtion’s image registration process is completed inside its PS1080 system-level chip, and all sensor information, color images, and depth images are transmitted to the user host through the USB interface. For example, the point of view can be placed in the heart, because the simulation occlusion must first find a suitable section to better observe and judge the occlusion effect. Therefore, this study uses the mouse interaction method to change the cutting by dragging and rotating the mouse. In the process of releasing the occluder, the parylene-coated occluder can be released after the X-ray and ultrasound examination results are satisfactory, and the delivery long sheath and catheter can be sprinkled and compressed to stop the bleeding. During the operation, the ASD measured by two-dimensional ultrasound after balloon inflation was 24.17 ± 7.94  mm, and the anterior and posterior diameter was 21.30 ± 6.54  mm. This research is helpful for the qualitative and quantitative diagnosis of congenital heart disease.

A 52-year-old woman with ventricular tachycardia

Heart ◽  
2018 ◽  
Vol 104 (24) ◽  
pp. 2025-2043 ◽  
Author(s):  
Ana Fidalgo ◽  
Leticia Fernandez-Friera ◽  
Jorge Solis
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Pulse Sequence ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
List Type ◽  
Oblique View ◽  
Cardiovascular Mr

Clinical introductionA 52-year-old woman with shortness of breath and palpitations was referred to a cardiologist. A 24-hour Holter demonstrated high density (37%) of ventricular premature beats (VPBs) and long runs of non-sustained (eventually sustained) monomorphic ventricular tachycardia (VT) with the same morphology as several VPBs detected in a 12-lead ECG (figure 1A). A transthoracic echocardiogram was performed, and the patient’s evaluation was completed with a functional and gadolinium-enhanced cardiovascular MR (CMR) study (figure 1B,C) to assess structural heart disease. In a follow-up visit, an electrophysiological study (EPS) was performed to identify the origin of VPBs and VT (figure 1D).Figure 1(A) A 12-lead ECG. (B) Cine CMR-SSFP (steady-state-free-precession) sequence on a three-chamber view. (C) Inversion-recovery gradient echo CMR pulse sequence for delayed enhancement assessment. (D) Three-dimensional electroanatomic voltage mapping of the left ventricular cavity (cranial left anterior oblique view). CMR, cardiovascular MR.QuestionWhat is the most likely cause of VPBs and VT?Idiopathic VT in the absence of structural heart disease.Bileaflet mitral valve prolapse (MVP).Dilated cardiomyopathy.Left ventricular non-compaction cardiomyopathy.Ischaemic cardiomyopathy.

Polymorphism of CYP3A4 isoenzyme gene in patients with chronic rheumatic heart disease

2021 ◽  
Vol 29 (2) ◽  
pp. 239-244
Author(s):  
Vadim S. Petrov ◽  
Alexander A. Nikiforov ◽  
Elena A. Smirnova
Keyword(s):  
Heart Disease ◽  
Endothelial Function ◽  
Rheumatic Heart Disease ◽  
Respiratory Function ◽  
Vital Capacity ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
The Right ◽  
Rheumatic Heart

AIM: This study aimed to identify the associations of CYP3A4 isoenzyme gene polymorphism with the parameters of echocardiography (EchoCG), spirometry, and endothelial function of patients with chronic rheumatic heart disease (CRHD). MATERIALS AND METHODS: A total of 128 patients with CRHD (15.6% men and 84.4% women) were examined. A392A, A392G, and G392G polymorphic markers were genotyped through polymerase chain reaction (PCR) with an SNP-EXPRESS electrophoretic scheme (NPF Litekh, Russia) to detect results after DNA was isolated from leukocytes in venous blood. EchoCG was implemented on an Affinity 50 apparatus (Philips, the Netherlands), endothelial function was assessed with an AngioScan01 apparatus (AngioScan-Electronics, Russia), and respiratory function was examined using a SpiroLab II spirometer (MIR Medical, Italy). RESULTS: The distance in a 6 min walk test did not show any significant differences among the groups: A392A 327.47 6.71 m, A392G 303.63 26.19 m, G392G 338.87 20.12 m (p=0.505). The area of the mitral opening was as follows: A392A 1.74 (1.67; 1.81) cm2, A392G 1.68 (1.45; 1.92) cm2, and G392G 1.65 (1.67; 1.81) cm2 (p = 0.214). As for the EchoCG parameters, the group of G392G homozygotes had the lowest linear dimensions of the left ventricle (the end diastolic dimension 4.83 (4.72; 4.95) cm, the end systolic dimension 2.97 (2.79; 3.14) cm, the right ventricle (2.45 [2.32; 2.58] cm), of the right atrium (4.09 [3.56; 4.62] cm), and the criteria of left ventricular hypertrophy (thickness of the interventricular septum 0.88 [0.81; 0.95] cm, and the posterior wall 0.88 (0.81; 0.95 cm). No statistically significant differences were found in the occlusion index amplitude among the groups, that is, single nucleotide replacements of CYP3A4 had no influence on the system of low-resistance arteries. Conversely, the values of the phase shift between channels (reflecting the condition of large arteries) significantly differed. The G392G polymorphism showed the worst parameters, and minimal changes were observed in the A392A group. Contour analysis demonstrated the highest augmentation index values in the G392G group, reflecting the maximal stiffness of vessels. The CYP3A4 polymorphism had no effect on the parameters of respiratory function in the studied cohort of patients. Spirometry revealed that the obstructive and restrictive parameters were not significant although homozygotes demonstrated the highest forced vital capacity of the lungs (76.5% [71.1% and 82.0%]) and forced expiratory volume for 1 s (84.6% [79.0% and 90.3%]). The maximal parameter of the vital capacity of the lungs in homozygotes for A392A (85.6% [82.3% and 88.8%]). CONCLUSION: Patients with CRHD homozygous for G392G had the minimum parameters of hypertrophy and dimensions of the left ventricular cavity. They also had the lowest values for the cavities of the right heart. CYP3A4 polymorphism had no effect on the parameters of respiratory function in the studied patients with CRHD.

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