Left Ventricular Noncompaction Cardiomyopathy (LVNC) with Left Ventricular Apical Thrombus– A Case Study

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy, with or without LV dysfunction, characterized by prominent trabeculations and associated deep recesses which communicate with the ventricular cavity rather than the coronary circulation. LVNC affects all age groups and can occur in isolation or association with other cardiac and systemic anomalies, especially with neuromuscular disorders. Patient may be asymptomatic or present with ventricular arrhythmias, thromboembolism, heart failure and sudden cardiac death. Echocardiography is the most common tool for diagnosis of LVNC. Contrast ventriculography, computed tomography (CT) and magnetic resonance imaging (MRI) are other useful diagnostic tools. Due to increasing awareness and improvement in imaging methods, LVNC is being diagnosed frequently in patients now a day. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 128-130

The Changing Paradigm in the Treatment of Structural Heart Disease and the Need for the Interventional Imaging Specialist

Percutaneous interventions in structural heart diseases are emerging rapidly. The variety of novel percutaneous treatment approaches and the increasing complexity of interventional procedures are associated with new challenges and demands on the imaging specialist. Standard catheterisation laboratory imaging modalities such as fluoroscopy and contrast ventriculography provide inadequate visualisation of the soft tissue or three-dimensional delineation of the heart. Consequently, additional advanced imaging technology is needed to diagnose and precisely identify structural heart diseases, to properly select patients for specific interventions and to support fluoroscopy in guiding procedures. As imaging expertise constitutes a key factor in the decision-making process and in the management of patients with structural heart disease, the sub-speciality of interventional imaging will likely develop out of an increased need for high-quality imaging.

Comparison of thallium deposition with segmental perfusion in pigs with chronic hibernating myocardium

Viable, chronically dysfunctional myocardium with reduced resting flow (or hibernating myocardium) is an important prognostic factor in ischemic heart disease. Although thallium-201 imaging is frequently used to assess myocardial viability in patients with ischemic cardiomyopathy, there are limited data regarding its deposition in hibernating myocardium, and this data suggest that thallium retention may be supernormal compared with control myocardium. Accordingly, pigs ( n = 7) were chronically instrumented with a 1.5 mm Delrin stenosis on the proximal left anterior descending coronary artery (LAD) to produce hibernating myocardium. Four months later, severe anteroapical hypokinesis was documented with contrast ventriculography (wall motion score, 0.7 ± 0.8; normal = 3), and microsphere measurements confirmed reduced resting flow (LAD subendocardium, 0.78 ± 0.34 vs. 0.96 ± 0.24 ml·min−1·g−1 in remote; P < 0.001). Absolute deposition of thallium-201 and insulin-stimulated [18F]-2 fluoro-2-deoxyglucose (FDG) were assessed over 1 h and compared with resting flow ( n = 704 samples). Thallium-201 deposition was only weakly correlated with perfusion ( r2 = 0.20; P < 0.001) and was more homogeneously distributed (relative dispersion, 0.12 ± 0.03 vs. 0.29 ± 0.10 for microsphere flow; P < 0.01). Thus after 1 h relative thallium-201 (subendocardium LAD/remote, 0.96 ± 0.16) overestimated relative perfusion (0.78 ± 0.32; P < 0.0001) and underestimated the relative reduction in flow. Viability was confirmed by both histology and preserved FDG uptake. We conclude that under resting conditions, thallium-201 redistribution in hibernating myocardium is nearly complete within 1 h, with similar deposition to remote myocardium despite regional differences in flow. These data suggest that in this time frame thallium-201 deposition may not discriminate hibernating myocardium from dysfunction myocardium with normal resting flow. Since hibernating myocardium has been associated with a worse prognosis, this limitation could have significant clinical implications.

Obstructive hydrocephalus due to a third ventricular neuroepithelial cyst

✓ Cysts occupying the third ventricle are rare lesions and may appear as an unusual cause of obstructive hydrocephalus. Various types of lesions occur in this location, and they generally have an arachnoidal, endodermal, or neuroepithelial origin. The authors present a case of acute hydrocephalus following minor trauma in a child due to cerebrospinal fluid outflow obstruction by a third ventricular cyst. Definitive diagnosis of this cystic lesion was possible only with contrast ventriculography and not routine computed tomography or magnetic resonance imaging. The investigation, treatment, and pathological findings are discussed.

Historical evolution of stereotactic amygdalotomy for the management of severe aggression

✓Friedrich Goltz first reported in the 1890s that temporal lobe removal had a taming effect in animals. The results of studies by Klüver and Bucy, and later Terzian and Ore, demonstrated that an amygdalectomy combined with a temporal lobectomy had a significant taming effect in both animals and humans. Based on these observations, Narabayashi and colleagues reported the first clinical series of patients with temporal lobe epilepsy and/or severe behavioral disturbances in which stereotactic amygdalotomy was performed to address aggressive disorders, using a frame-based stereo-tactic device designed by Narabayashi. Use of pneumoencephalography, combined with physiological localization by means of olfactory stimulation and field potential recordings, enabled these investigators to define the lateral part of the amygdala, while simultaneously using wax injections to create lesions. Chitanondh used a similar localization technique to produce medial amygdala lesions by injecting a mixture of olive oil, wax, and iodized oil. In 1966, Heimburger and coworkers reported results from a series of 25 patients with epilepsy and aggressive behavior who underwent stereotactic amygdalotomy. Their technique was slightly different and their target localization was solely anatomical, based on pneumoencephalography or contrast ventriculography, and they utilized a cryoprobe to make lesions. In 1970, Balasubramaniam and Ramamurthi reported the largest clinical series to date on this technique; pneumoencephalography or contrast ventriculography was used for anatomical localization, and depth electrode recordings were used to obtain physiological confirmation of their targets, whereas either diathermy or a Bertrand loop was used for making lesions. The development of magnetic resonance imaging technology in late 1980 allowed for a more accurate anatomical localization of the amygdala, and the improvement of radiofrequency generators also made lesioning more precise. Despite these and subsequent technological advances, the number of amygdalotomies performed has geometrically decreased during the last 20 years.