scholarly journals Case Report: Assessing the Position of Pacemaker Leads via Transthoracic Echocardiography: Additional Value of the Subcostal En Face View

2021 ◽  
Vol 8 ◽  
Author(s):  
Andrea Simone Deichl ◽  
Philipp Lacour ◽  
Evgeny Belyavskiy ◽  
Burkert Pieske ◽  
Elisabeth Pieske-Kraigher ◽  
...  
Keyword(s):  
Transthoracic Echocardiography ◽  
Case Series ◽  
Direct Interaction ◽  
Subsequent Development ◽  
Cardiac Implantable Electronic Devices ◽  
Chamber View ◽  
En Face ◽  
Pacemaker Leads ◽  
Face View ◽  
Additional Value

There is an association between presence of cardiac implantable electronic devices (CIED) and development of tricuspid regurgitation (TR). Mechanisms proposed to explain CIED-induced TR can be classified as implantation-related, lead-related, and pacing-related. Lead-related TR results from the direct interaction of the lead with the tricuspid valve (TV). The localization of the lead at the TV level directly influences the probability of subsequent development of significant TR. A transthoracic subcostal en face view of the TV can be acquired in most patients through a 90° rotation from the subcostal 4-chamber view with clear anatomic delineation of the TV and the commissures including lead position. This case-series presents three examples where the transthoracic en face view could add incremental information on the position of the pacemaker leads and on the mechanism of TR.Conclusion: When performing transthoracic echocardiography in patients with trans-tricuspid CIED lead(s), an en face view of the TV with exact reporting of the position of the lead(s) should be included.

Focal TLR4 activation mediates disturbed flow-induced endothelial inflammation

2019 ◽  
Vol 116 (1) ◽  
pp. 226-236 ◽  
Author(s):  
Dan Qu ◽  
Li Wang ◽  
Mingyu Huo ◽  
Wencong Song ◽  
Chi-Wai Lau ◽  
...  
Keyword(s):  
Vascular Inflammation ◽  
Subsequent Development ◽  
Tlr4 Expression ◽  
Disturbed Flow ◽  
Atherosclerotic Lesions ◽  
Endothelial Inflammation ◽  
En Face ◽  
Induced Flow ◽  
Tlr4 Activation

Abstract Aims Disturbed blood flow at arterial branches and curvatures modulates endothelial function and predisposes the region to endothelial inflammation and subsequent development of atherosclerotic lesions. Activation of the endothelial Toll-like receptors (TLRs), in particular TLR4, contributes to vascular inflammation. Therefore, we investigate whether TLR4 can sense disturbed flow (DF) to mediate the subsequent endothelial inflammation. Methods and results En face staining of endothelium revealed that TLR4 expression, activation, and its downstream inflammatory markers were elevated in mouse aortic arch compared with thoracic aorta, which were absent in Tlr4mut mice. Similar results were observed in the partial carotid ligation model where TLR4 signalling was activated in response to ligation-induced flow disturbance in mouse carotid arteries, and such effect was attenuated in Tlr4mut mice. DF in vitro increased TLR4 expression and activation in human endothelial cells (ECs) and promoted monocyte-EC adhesion, which were inhibited in TLR4-knockdown ECs. Among endogenous TLR4 ligands examined as candidate mediators of DF-induced TLR4 activation, fibronectin containing the extra domain A (FN-EDA) expressed by ECs was increased by DF and was revealed to directly interact with and activate TLR4. Conclusion Our findings demonstrate the indispensable role of TLR4 in DF-induced endothelial inflammation and pinpoint FN-EDA as the endogenous TLR4 activator in this scenario. This novel mechanism of vascular inflammation under DF condition may serve as a critical initiating step in atherogenesis.

scholarly journals Characterizing Flow and Structure of Diabetic Retinal Neovascularization after Intravitreal Anti-VEGF Using Optical Coherence Tomography Angiography: A Pilot Study

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Christof Haensli ◽  
Katrin Fasler ◽  
Daniel Barthelmes ◽  
Sandrine A. Zweifel
Keyword(s):  
Optical Coherence Tomography ◽  
Initial Treatment ◽  
Measurement Method ◽  
Optical Coherence Tomography Angiography ◽  
Case Series ◽  
Retinal Neovascularization ◽  
Flow Density ◽  
Optical Coherence ◽  
En Face

Background/Aims. This study evaluates changes of flow and structure of diabetic retinal neovascularization (NV) treated with intravitreal antivascular endothelial growth factor (VEGF) agents using optical coherence tomography angiography (OCTA). With OCTA, retinal blood vessels are visualized at high resolution to separately look at flow and structure information without the need for dye injection. We introduce a new measurement method including and combining information of flow and structure. Methods. Retrospective observational case series. Patients with proliferative diabetic retinopathy (PDR) were treated with intravitreal antiVEGF injections. Retinal NV were repeatedly imaged using swept-source OCTA (Zeiss PlexElite 9000) at baseline, after initial treatment block with 3-4 monthly injections, and during a follow-up period of up to 51 weeks. Change of size and flow density of the structural and angio area of NV was assessed. Results. Nine NV in eight eyes of five patients were analyzed with a median follow-up time of 45 weeks. After the initial treatment block, en face structural area regressed, 18.7% ± 39.0% (95% CI 44.2–6.8%, p = 0.26 ), and en face angio area regressed, 51.9% ± 29.5% (95% CI 32.6 to 71.2%, p = 0.007 ). Flow density within the en face structural area decreased by 33% ± 19.2% (95% CI 20.5–45.5%, p = 0.0077 ). Flow density within the en face angio area decreased by mean 17.9% ± 25.2% (95% CI 1.4–34.4%, p = 0.066 ). In two fellow eyes, NV recurrence could be observed before the onset of vitreous bleeding in one. Conclusion. Our study introduces a new quantitative measurement for NV in PDR, combining structure and flow measurement. The structure area remained after treatment, while its flow density and angio area regressed. We propose this measurement method as a more physiological and possibly more comparable metrics.

scholarly journals mRNA COVID-19 Vaccination and Development of CMR-confirmed Myopericarditis

2021 ◽  
Author(s):  
Tahir Kafil ◽  
Mariana M Lamacie ◽  
Sophie Chenier ◽  
Heather Taggart ◽  
Nina Ghosh ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
T2 Mapping ◽  
Academic Medical Center ◽  
Case Series ◽  
Vaccine Dose ◽  
Subsequent Development ◽  
Health Agency ◽  
Cine Imaging ◽  
Gadolinium Enhancement ◽  
Post Contrast

Introduction: Several case reports or small series have suggested a possible link between mRNA COVID vaccines and the subsequent development of myocarditis and pericarditis. This study is a prospective collection and review of all cases with a myocarditis/pericarditis diagnosis over a 2-month period at an academic medical center. Methods: Prospective case series from 1st June 2021 until 31st July 2021. Patients were identified by admission and discharge diagnoses which included myocarditis or pericarditis. Inclusion criteria were: in receipt of mRNA vaccine within one month prior to presentation; The CMR protocol included cine imaging, native T1 and T2 mapping, late gadolinium enhancement and post contrast T1 mapping. All CMR studies were read in consensus by two experienced readers. Diagnosis was based on clinical presentation, ECG/echo findings and serial troponins and was confirmed in each case by CMR. Incidence was estimated from total doses of mRNA vaccine administered in the Ottawa region for the matching time-period. This data was obtained from the Public Health Agency of Ottawa. Results: 32 patients were identified over the period of interest. Eighteen patients were diagnosed with myocarditis; 12 with myopericarditis; and 2 with pericarditis alone. The median age was 33 years (18-65 years). The sex ratio was 2 females to 29 male. In 5 cases, symptoms developed after only a single dose of mRNA vaccine. In 27 patients, symptoms developed after their second dose of. Median time between vaccine dose and symptoms was 1.5 days (1-26 days). Chest pain was the commonest symptom, but many others were reported. Non-syncopal non-sustained ventricular tachycardia was seen in only a single case. Median LV ejection fraction (EF) was 57% (44-66%). Nine patients had an LVEF below the normal threshold of 55%. Incidence of myopericarditis overall was approximately 10 cases for every 10,000 innoculations. Summary and Conclusions: This is the largest series in the literature to clearly relate the temporal relationship between mRNA COVID vaccination, symptoms and CMR findings. In most patients, symptom onset began within the first few days after vaccination with corresponding abnormalities in biomarkers and on ECG. Cardiac MRI confirmed acute myocardial and pericardial changes with the presence of edema demonstrated with both tissue mapping and late gadolinium enhancement. Symptoms settled quickly with standard therapy and patients were discharged within a few days. No major adverse cardiac events and no significant arrhythmias were noted during inpatient stay. Further follow up will be required to ascertain the longer-term outcomes of this patient group.

Left Stellate Ganglion Block for Refractory Ventricular Tachycardia: A Case Series

2021 ◽  
Vol 104 (3) ◽  
pp. 506-511
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmia ◽  
Stellate Ganglion ◽  
Case Series ◽  
Stellate Ganglion Block ◽  
Definitive Treatment ◽  
Ganglion Block ◽  
Cardiac Implantable Electronic Devices ◽  
Left Stellate Ganglion ◽  
Life Threatening

Ventricular arrhythmias are usually well controlled with medical management, cardiac implantable electronic devices, or catheter ablation. However, the refractory ventricular tachycardia or fibrillation (VT/VF) is life threatening and challenging. The authors reported a case series of left stellate ganglion blocks (LSGB) in patients with refractory VT/VF, who failed pharmacological treatment and multiple traditional cardiac interventions. Five patients underwent six LSGB. Four patients had significant decreased in ventricular arrhythmia burden. Among the responders, the LSGB suppressed significant VT/VF for three to seven days. Blocks did not only temporary suppress ventricular arrhythmia, but also stabilized the condition and served as a bridge to definitive treatment such as EP ablation or heart transplantation. There was no significant hemodynamic change or devastating side effects. The outcome from the present case series suggested that LSGB could be an effective treatment and a lifesaving intervention frintractable VT/VF. Keywords: Stellate ganglion block, Refractory ventricular tachycardia, Sympathectomy

scholarly journals Utility of en-face imaging in diagnosis of occult macular dystrophy with RP1L1 mutation: A case series

2019 ◽  
Vol 15 ◽  
pp. 100465 ◽  
Author(s):  
Merry ZC. Ruan ◽  
S. Amal Hussnain ◽  
Amanda Thomas ◽  
Mahesh Mansukhani ◽  
Stephen Tsang ◽  
...  
Keyword(s):  
Case Series ◽  
Macular Dystrophy ◽  
Occult Macular Dystrophy ◽  
En Face ◽  
En Face Imaging

scholarly journals Imaging of the Unstable Shoulder

2017 ◽  
Vol 11 (1) ◽  
pp. 882-896 ◽  
Author(s):  
Paolo Baudi ◽  
Manuela Rebuzzi ◽  
Giovanni Matino ◽  
Fabio Catani
Keyword(s):  
Bone Defects ◽  
Anterior Dislocation ◽  
Anterior Shoulder Instability ◽  
Imaging Features ◽  
3D Ct ◽  
Ct Reconstruction ◽  
Acute Setting ◽  
Clinical Scenarios ◽  
En Face ◽  
Face View

Background: Unstable shoulder can occur in different clinical scenarios with a broad spectrum of symptoms and presentations: first-time (or recurrent) traumatic acute shoulder anterior dislocation or chronic anterior instability after repeated dislocations. Imaging in unstable shoulder is fundamental for choosing the right treatment preventing recurrence. The goal of imaging depends on clinical scenario and patient characteristics. Method: Careful selection and evaluation of the imaging procedures is therefore essential to identify, characterize and quantify the lesions. Proper imaging in unstable shoulder cases is critical to the choice of treatment to prevent recurrence, and to plan surgical intervention. Results: In acute setting, radiographs have to roughly detect and characterize the bone defects present. At about 7 days, it is recommended to perform a MR to demonstrate lesions to labrum and/or ligaments and bone defects: in acute setting, the MRA is not necessary, because of effusion and hemarthrosis that behave as the contrast medium. In recurrence, it is fundamental not only to detect lesions but characterize them for planning the treatment. The first study to do is the MRI (with a magnetic field of at least 1.5 Tesla), and if possible MRA, above all in younger patients. Then, on the basis of the pathologic findings as bipolar lesion or severity of bone defects, CT can be performed. PICO method on 2D or 3D CT is helpful if you need to study a glenoid bone loss, with the “en face view” of glenoid, while a 3D CT reconstruction with the humeral head “en face view” is the gold standard to assess an Hill-Sachs lesion. Conclusion: The clinical diagnoses of anterior shoulder instability can be different and acknowledgement of imaging findings is essential to guide the treatment choice. Imaging features are quite different in chronic than in acute scenario. This requires appropriate indications of many different imaging techniques.

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