scholarly journals Effectiveness of a patient-specific 3-dimensional printed model in Septal Myectomy of hypertrophic cardiomyopathy

2020 ◽  
Vol 36 (7) ◽  
Author(s):  
Yang Wang ◽  
Hongchang Guo ◽  
Shengwei Wang ◽  
Yongqiang Lai
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Patient Specific ◽  
Class Iii ◽  
3 Dimensional ◽  
Septal Myectomy ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
3D Printed

Objective: Advanced cardiovascular surgery in structural heart disease require accurate pre-operative evaluation. Most of non-invasive imaging technologies remain limited in two-dimensional and show insufficiency of visualization for procedural planning. The aim of this study was to discuss the value of patient-specific 3-dimensional (3D) printing in treatment of hypertrophic cardiomyopathy (HCM). Methods: Patient-specific 3D-printed models were constructed preoperatively in 12 consecutive HOCM patients which come to Beijing Anzhen Hospital for surgical treatment from October 2016 to March 2017. Image files were extracted from multi-slice computed tomography images, 3D models were constructed by the Mimics 19.0 software and generated by Objet350 Connex3 3D printer. The 3D-printed models were made with soft material that can be surgically performed. The modified Morrow myectomy of the model was performed before the operation. Clinical characters and echocardiographic parameters were recorded. Results: There was no significant difference in tissue volume between the models and specimens. Preoperative and postoperative echocardiography showed the septal thickness was reduced from 18.8±4.5 mm to 12.7±3.3 mm (p<0.001), the left ventricular outflow tract obstruction was adequately relieved (83.0±27.73 mm Hg to 8.7±6.5 mm Hg, p<0.001), and the SAM disappeared completely after the operation. Cardiac function was improved in all patients (New York Heart Association functional class III to class I/II). Conclusions: The proposed optimal 3D-modelled septal myectomy allows intraoperative monitoring of the shape and volume of the myocardium resection to achieve the ‘ideal’ interventricular septum. It eliminates obstruction in the LVOT and SAM, resulting in LV remodeling with an increase in LV end-diastolic volume and diameter at early follow-up. doi: https://doi.org/10.12669/pjms.36.7.2620 How to cite this:Wang Y, Guo H, Wang S, Lai Y. Effectiveness of a patient-specific 3-dimensional printed model in Septal Myectomy of hypertrophic cardiomyopathy. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2620 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals A new approach to the assessment of outcomes of alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

2015 ◽  
Vol 17 (2) ◽  
pp. 46
Author(s):  
A. G. Osiev ◽  
Ye. I. Kretov ◽  
V. P. Kurbatov ◽  
S. P. Mironenko ◽  
R. A. Naydenov ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Interventricular Septum ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Alcohol Septal Ablation ◽  
New Approach ◽  
Surgical Interventions ◽  
Septal Myectomy ◽  
Left Ventricular Output ◽  
Cardiac Disorders

Hypertrophic cardiomyopathy is a heterogeneous disease characterized by myocardial hypertrophy, without any other systemic or cardiac disorders and with predominant involvement of the interventricular septum. Approximately 25% of patients have a dynamic obstruction of the left ventricular output tract due its constriction and abnormal systolic anterior motion of the mitral valve. Therapeutic strategy for patients with hypertrophic obstructive cardiomyopathy, who remain symptomatic despite drug therapy, includes surgery (septal myectomy) and non-surgical interventions, such as alcohol septal ablation. In the present study the possibility of cardiac MRI with contrast enhancement in the evaluation of the results of endovascular treatment hypertrophic cardiomyopathy and evidence for the benefits of this method in 25 patients with an obstructive form of hypertrophic cardiomyopathy after alcohol septal ablation are discussed.

scholarly journals P1321 A case of multiple levels of ventricular obstruction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Oikonomidis ◽  
A Klitirinos ◽  
M Koutouzis ◽  
A Kalangos ◽  
E Lazaris ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Imaging Modalities ◽  
Subaortic Stenosis ◽  
Shortness Of Breath ◽  
Septal Myectomy ◽  
Subaortic Membrane

Abstract Subaortic stenosis (SAS) is a rare entity in adults with unclear etiology and variable presentation. SAS may be presented with symptoms mimicking Hypertrophic Cardiomyopathy (HCM). Often a combination of imaging modalities is needed to distinguish SAS from HCM with obstruction. A 53 years old man, smoker, was referred to our medical center suffering from shortness of breath on exertion. He first presented at another facility with a 2 month history of shortness of breath and chest discomfort during brisk physical activity and the possible diagnosis of HCM was made. On physical examination, a 3/6 systolic murmur was audible along the left sternal border, that became louder with standing and the Valsalva maneuver. The patient had non distended jugular veins, clear lung fields and no ankle edema. The results of laboratory exams did not reveal any pathological sign. The transthoracic echocardiogram revealed significant left ventricular hypertrophy (Interventricular septum 21 mm, Posterior wall 16 mm) with normal left ventricular systolic performance (ejection fraction &gt;70%). The aortic valve was tricuspid and calcified whereas mitral valve was morphologically normal, with systolic anterior motion and mild posterolaterally directed regurgitation. Two systolic gradients, one dynamic, late peaking of 85mmHg and another fixed of 70mmHg were detected in left ventricular outflow track (LVOT). Transesophageal echocardiography was performed for the better evaluation of aortic valve and showed a three level obstruction caused by the systolic motion of the mitral valve towards the hypertrophic septum at LVOT, the presence of a membranous subaortic membrane and the calcified aortic valve respectively. The aortic valve was calcified with a moderate stenosis (0.8cm2 / m2) from 3D planimetry. A Cardiac Magnetic Resonance exam was ordered and confirmed the significance of hypertrophy and the presence of circumferential subaortic membrane. No late enhancement after the administration of Gadolinium was observed. Coronary angiography was performed and demonstrated normal coronary arteries. We hypothesized that the presence of subaortic membrane led to marked myocardial wall thickness and to the destruction of the aortic valve due to turbulent flow in the LVOT. The patient was referred for surgical management Extended septal myectomy combined with complete resection of orbital subaortic membrane were performed. he calcified aortic valve was replaced by bioprosthetic valve No 23mm. The patient tolerated the procedure well with significant symptomatic improvement. TTE performed 1 month postoperatively showed no remarkable LVOT gradient. The results of histopathology and genes investigations are pending. Subaortic membrane is a rare cause of symptoms that can mimic hypertrophic cardiomyopathy. A combination of imaging modalities is needed to distinguish subaortic stenosis from aortic valve stenosis and hypertrophic obstructive cardiomyopathy. Abstract P1321 Figure. Three levels obstruction

scholarly journals Patient-Specific 3-Dimensional Printed Models for Planning Nasal Osteotomy to Correct Nasal Deformities Due to Trauma

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2092434
Author(s):  
Yong Gi Jung ◽  
Hanaro Park ◽  
Jiwon Seo
Keyword(s):  
Fused Deposition Modeling ◽  
Nasal Bone ◽  
Patient Specific ◽  
3 Dimensional ◽  
Fused Deposition ◽  
Computed Tomography Images ◽  
Real Size ◽  
Deposition Modeling ◽  
3D Printed ◽  
3D Printing Technique

Nasal deformities due to trauma are more challenging to correct with rhinoplasty than nasal deformities of nontraumatic causes. Nasal osteotomy is an essential procedure for bone deviations. Preoperative planning is vital in these cases, but it is challenging to comprehend 3-dimensional (3D) structures of the nasal bone on 2-dimensional facial photographs and computed tomography images. We used a 3D-printing technique to fabricate real-size facial bone models with similar physical properties and texture as the actual bone. Furthermore, we established a precise surgical plan using simulated osteotomy on the 3D-printed model. Fused deposition modeling–type desktop 3D printer with polylactic acid filaments was used. A surgical plan was established using simulated osteotomy in 11 cases, and the actual surgery was performed as planned in 10 cases (90.9%). The 3D-printed model and stimulated osteotomy were useful for precise planning of osteotomy to correct nasal deformities due to trauma.

scholarly journals THE PLACE OF CARDIAC COMPUTED TOMOGRAPHY IN PREOPERATIVE PLANNING OF EXTENDED SEPTAL MYECTOMY IN PATIENTS WITH OBSTRUCTIVE FORM OF HYPERTROPHIC CARDIOMYOMATHY

2020 ◽  
Vol 25 ◽  
pp. 592-606
Author(s):  
M. Tregubova ◽  
◽  
K. Rudenko ◽  
V. Lazoryshynets ◽  
S. Fedkiv ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hypertrophic Cardiomyopathy ◽  
Cardiac Ct ◽  
Preoperative Planning ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Study Group ◽  
Technical Problems ◽  
Septal Myectomy ◽  
Preoperative Ct

Background. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Extended septal myectomy ( ESM) is one of the priority methods of treatment of drug-refractory obstructive HCM. In recent years, hospital mortality during surgical correction of obstructive HCM in expert centers does not exceed 1–2 %. However, typical threatening complications of septal myectomy, such as iatrogenic ventricular septal defect (VSD) and rupture of the anterior or posterior walls of the left ventricle (LV), remain a topical issue in surgery of HCM. Objective: to show the role of preoperative CT-planning to predict and reduce possible technical problems associated with ESM, including iatrogenic VSD. Methods and materials. This study includes 217 symptomatic patients with obstructive HCM, who from April 2016 to October 2019 as one of the steps of preoperative planning underwent cardiac CT prior to ESM. Cardiac CT was performed to delineate the left ventricular myocardium, assess the distribution of hypertrophy and the presence of crypts. Special attention was also paid to the anatomy of the mitral valve (MV) and subvalvular apparatus. Coronary artery patency was assessed by CAD-RADS, a standardized method for reporting the results of coronary CT angiography to determine tactics for further management of the patient. Results and discussion. In the study group, the average age of patients was (49 ± 15) years, 48 % – men. All patients had a symptomatic, drug-refractory obstructive form of HCM. The mean maximum wall thickness of the interventricular septum (IVS) was (20 ± 5) mm (range 16–33). The average LV mass was (118 ± 23) g/m2. 195 patients (89.9 %) had systolic anterior motion ( SAM) of the MV. MV and subvalvular apparatus anomalies were detected in 62 patients (28.6 %). A zone of scarring and regression of IVS after alcohol septal ablation (ASA) was detected in 7 patients (0.3 %) with residual LV outflow gradient. Coronary arteries atherosclerosis was detected in 32 patients (14.7 %). Conclusions. Preoperative CT-planning of septal myectomy allows to obtain information on morphology of the LV, IVS, MV and subvalvular apparatus, and gives the surgeon the advantage to form a more accurate plan for the location and volume of septal resection, and avoid complications when correcting obstructive HCM. No iatrogenic VSD was detected in any of the patient in the study group. Key words: hypertrophic cardiomyopathy, computed tomography, preoperative planning, extended septal myectomy.

scholarly journals Image-Based Computational Hemodynamics Analysis of Systolic Obstruction in Hypertrophic Cardiomyopathy

2022 ◽  
Vol 12 ◽  
Author(s):  
Ivan Fumagalli ◽  
Piermario Vitullo ◽  
Christian Vergara ◽  
Marco Fedele ◽  
Antonio F. Corno ◽  
...  
Keyword(s):  
Blood Flow ◽  
Hypertrophic Cardiomyopathy ◽  
Pathological Condition ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Patient Specific ◽  
Cine Mri ◽  
Septal Myectomy ◽  
Blood Flow Dynamics

Hypertrophic Cardiomyopathy (HCM) is a pathological condition characterized by an abnormal thickening of the myocardium. When affecting the medio-basal portion of the septum, it is named Hypertrophic Obstructive Cardiomyopathy (HOCM) because it induces a flow obstruction in the left ventricular outflow tract. In any type of HCM, the myocardial function can become compromised, possibly resulting in cardiac death. In this study, we investigated with computational analysis the hemodynamics of patients with different types of HCM. The aim was quantifying the effects of this pathology on the intraventricular blood flow and pressure gradients, and providing information potentially useful to guide the indication and the modality of the surgical treatment (septal myectomy). We employed an image-based computational approach, integrating fluid dynamics simulations with geometric and functional data, reconstructed from standard cardiac cine-MRI acquisitions. We showed that with our approach we can better understand the patho-physiological behavior of intraventricular blood flow dynamics due to the abnormal morphological and functional aspect of the left ventricle. The main results of our investigation are: (a) a detailed patient-specific analysis of the blood velocity, pressure and stress distribution associated to HCM; (b) a computation-based classification of patients affected by HCM that can complement the current clinical guidelines for the diagnosis and treatment of HOCM.

scholarly journals The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammad Amin Abazari ◽  
Deniz Rafieianzab ◽  
M. Soltani ◽  
Mona Alimohammadi
Keyword(s):  
Aortic Dissection ◽  
Clinical Decision Making ◽  
Beta Blockers ◽  
False Lumen ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Patient Specific ◽  
Type B ◽  
Windkessel Model ◽  
Computed Tomography Images

AbstractAortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.

scholarly journals Effects of candesartan on left ventricular hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Maqsood ◽  
H.A Shakeel ◽  
H.F Shoukat ◽  
M.D Khan ◽  
S.A.Y Shah ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Interstitial Fibrosis ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Funding Source ◽  
Gadolinium Enhancement ◽  
Percent Change ◽  
Lv Mass ◽  
Significant Difference

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular (LV) hypertrophy in the absence of pressure overload. Manifestations of the disease include heart failure associated with diastolic dysfunction and atrial and ventricular tachyarrhythmias. Pathological features of HCM include myocyte hypertrophy, interstitial fibrosis, and myocyte disarray and are mediated by angiotensin II. Purpose This study aimed to evaluate the effects of candesartan on left ventricular (LV) hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy (HCM). Methods In double-blind fashion, 30 patients (6 women, 24 men; age: 55±11 years) with HCM were randomly assigned to receive placebo (n=13) or candesartan 50 mg twice a day (n=17) for 1 year. To measure LV mass and extent of fibrosis, cardiac magnetic resonance imaging was performed at baseline and 1 year as assessed by late gadolinium enhancement. Results There was a trend toward a significant difference in the percent change in LV mass (median: +5% with placebo vs. −5% with candesartan; p=0.06). There was a significant difference in the percent change in the extent of late gadolinium enhancement, with the placebo group experiencing a larger increase (+30±27% with placebo vs. −22±44% with candesartan; p=0.03). Conclusion Our study concludes reduction of the progression of myocardial hypertrophy and fibrosis with candesartan in patients with hypertrophic cardiomyopathy. Our study population was limited so we warrant larger trials to confirm a place for angiotensin receptor blockers in the management of patients with hypertrophic cardiomyopathy. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): Self funding

Epicardial fat thickness in infants of diabetic mothers

2021 ◽  
pp. 1-6
Author(s):  
M.M. Vela-Huerta ◽  
N. Amador-Licona ◽  
R. Domínguez-Damiá ◽  
A. Heredia-Ruiz ◽  
H.V. Orozco-Villagomez ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Left Ventricular ◽  
Epicardial Fat ◽  
Left Ventricular Ejection ◽  
Epicardial Fat Thickness ◽  
Infants Of Diabetic Mothers ◽  
Significant Difference ◽  
Echocardiographic Parameters ◽  
Fat Thickness ◽  
Diabetic Mothers

BACKGROUND: Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters. METHODS: We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined. RESULTS: There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, p <  0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, p <  0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, p = 0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; p <  0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (r = 0.577; p = 0.0001), LVPW (r = 0.262; p = 0.011), IVST/LVPW index (r = 0.353; p = 0.001), and mitral integral early velocity (r = 0.313; p = 0.002), while a negative correlation with LVFE was observed (r = –0.376; p = 0.0001). CONCLUSIONS: The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.

scholarly journals Echocardiographic Assessment of Cardiac Structural and Functional Indices in Broiler Chickens Treated with Silver Nanoparticles

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Hamid Raieszadeh ◽  
Vahid Noaman ◽  
Mehrdad Yadegari
Keyword(s):  
Broiler Chickens ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Internal Diameter ◽  
Treatment Groups ◽  
Randomized Design ◽  
Linear Probe ◽  
Significant Difference ◽  
Echocardiographic Assessment ◽  
Fractional Shortening

270 Ross broiler chickens of twenty days old were housed in 18-floor pens in a completely randomized design with six treatment groups and three replicate groups and fifteen chicks per each pen. The treatment groups (1–6) consisted of 0, 10, 20, 30, 50, and 70 ppm of nanocide in drinking water, respectively. At 26 days of age, 3 chickens were selected randomly for echocardiography using a 7.5 MHz linear probe, and the left ventricular internal diameter at the end of diastole (LVIDd), left ventricular internal diameter at the end of systole (LVIDs), left ventricular fractional shortening (LVFS), ejection fraction (EF), stroke volume (SV), interventricular septum thickness at the end of systole (IVSTs), and interventricular septum thickness at the end of diastole (IVSTd) were evaluated. LVIDd and LVIDs in group six were of higher rate than other groups and showed statistically significant differences with groups two, three, and four (P<0.05). LVFS, percentage of EF, and IVSTd were minimum in group six and had significant difference with other groups (P<0.05). The results of this study showed that prescription of high dosage of nanocide leads to cardiovascular problems with decrease in myocardial contractility and increase in the internal diameter of left ventricle.

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