Utilization of Contrast Echocardiography to Detect Coronary Perforation

Coronary artery perforation (CAP) is a potentially fatal complication following percutaneous coronary intervention. The suspicion for post-procedural CAP typically arises from the development of clinical hemodynamic instability of the patient and evidence of new or worsening pericardial effusion in bedside echocardiography. Following such suspicion, emergent pericardiocentesis and immediate repeated coronary angiography should be performed to assess for coronary perforation. The use of echo-contrast material, currently used to improve echocardiographic resolution and provide real-time assessment of intracardiac blood flow evaluation, has yet been described to facilitate diagnosis of such infrequent complication without delaying invasive treatment in this setting.

A hybrid of light-field and light-sheet imaging to study myocardial function and intracardiac blood flow during zebrafish development

Biomechanical forces intimately contribute to cardiac morphogenesis. However, volumetric imaging to investigate the cardiac mechanics with high temporal and spatial resolution remains an imaging challenge. We hereby integrated light-field microscopy (LFM) with light-sheet fluorescence microscopy (LSFM), coupled with a retrospective gating method, to simultaneously access myocardial contraction and intracardiac blood flow at 200 volumes per second. While LSFM allows for the reconstruction of the myocardial function, LFM enables instantaneous acquisition of the intracardiac blood cells traversing across the valves. We further adopted deformable image registration to quantify the ventricular wall displacement and particle tracking velocimetry to monitor intracardiac blood flow. The integration of LFM and LSFM enabled the time-dependent tracking of the individual blood cells and the differential rates of segmental wall displacement during a cardiac cycle. Taken together, we demonstrated a hybrid system, coupled with our image analysis pipeline, to simultaneously capture the myocardial wall motion with intracardiac blood flow during cardiac development.

An isolated beating pig heart platform for a comprehensive evaluation of intracardiac blood flow with 4D flow MRI: a feasibility study

Background Cardiac magnetic resonance imaging (MRI) in large animals is cumbersome for various reasons, including ethical considerations, costs of housing and maintenance, and need for anaesthesia. Our primary purpose was to show the feasibility of an isolated beating pig heart model for four-dimensional (4D) flow MRI for investigating intracardiac blood flow patterns and flow parameters using slaughterhouse side products. In addition, the feasibility of evaluating transcatheter aortic valve replacement (TAVR) in the model was investigated. Methods Seven slaughterhouse pig hearts were installed in the MRI-compatible isolated beating pig heart platform. First, Langendorff perfusion mode was established; then, the system switched to working mode, in which blood was actively pumped by the left ventricle. A pacemaker ensured a stable HR during 3-T MRI scanning. All hearts were submitted to human physiological conditions of cardiac output and stayed vital for several hours. Aortic flow was measured from which stroke volume, cardiac output, and regurgitation fraction were calculated. Results 4D flow MRI acquisitions were successfully conducted in all hearts. Stroke volume was 31 ± 6 mL (mean ± standard deviation), cardiac output 3.3 ± 0.9 L/min, and regurgitation fraction 16% ± 9%. With 4D flow, intracardiac and coronary flow patterns could be visualised in all hearts. In addition, we could study valve function and regurgitation in two hearts after TAVR. Conclusions The feasibility of 4D flow MRI in an isolated beating pig heart loaded to physiological conditions was demonstrated. The platform is promising for preclinical assessment of cardiac blood flow and function.

Inverse Problem for Color Doppler Ultrasound-Assisted Intracardiac Blood Flow Imaging

For the assessment of the left ventricle (LV), echocardiography has been widely used to visualize and quantify geometrical variations of LV. However, echocardiographic image itself is not sufficient to describe a swirling pattern which is a characteristic blood flow pattern inside LV without any treatment on the image. We propose a mathematical framework based on an inverse problem for three-dimensional (3D) LV blood flow reconstruction. The reconstruction model combines the incompressible Navier-Stokes equations with one-direction velocity component of the synthetic flow data (or color Doppler data) from the forward simulation (or measurement). Moreover, time-varying LV boundaries are extracted from the intensity data to determine boundary conditions of the reconstruction model. Forward simulations of intracardiac blood flow are performed using a fluid-structure interaction model in order to obtain synthetic flow data. The proposed model significantly reduces the local and global errors of the reconstructed flow fields. We demonstrate the feasibility and potential usefulness of the proposed reconstruction model in predicting dynamic swirling patterns inside the LV over a cardiac cycle.