Limitations of classical left ventricular hypertrophy electrocardiographic criteria in hypertrophic cardiomyopathy: Transferring cardiac electrical activity onto a 3D heart model in a patient with recurrent ventricular fibrillations.

Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers' understanding of patients' congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients' CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery. Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU. Providers completed a Likert questionnaire evaluating the models' value in understanding anatomy and improving care delivery. Responses were compared using two-tailed t test and Mann-Whitney U test and were also compared to previously collected CICU provider responses regarding use of printed 3D heart models. Fifty-three clinicians (19 physicians, 34 nurses/trainees) participated; 49 (92%) of 53 and 44 (83%) of 53 reported at least moderate to high satisfaction with the virtual 3D heart's ability to enhance understanding of anatomy and surgical repair, respectively. Seventy-one percent of participants felt strongly that virtual 3D models improved their ability to manage postoperative problems. The majority of both groups (63% physicians, 53% nurses) felt that virtual 3D heart models improved CICU handoffs. Virtual 3D heart models were as effective as printed models in improving understanding and care delivery, with a noted provider preference for printed 3D heart models. Virtual 3D heart models depicting patient-specific CHDs are perceived to improve understanding and postoperative care delivery in the CICU.

The objective of this review is to evaluate the effectiveness of three-dimensional (3D) heart models as teaching tools for congenital heart disease (CHD), addressing the limitations of traditional medical education methods. A thorough literature review was conducted using PubMed, Google Scholar, Scientific Direct and Scopus databases. Relevant articles were screened and selected based on their discussion of the application of 3D models in CHD education. The comprehensive review of 19 studies revealed that 3D heart models provide students, healthcare professionals, and patients with meaningful experiences that significantly enhance understanding and learning outcomes. These models improve objective knowledge, structural conceptualization, and personal satisfaction in medical education, especially in complex CHD compared to traditional methods such as books and 2D images ( p< 0.001). Additionally, they enhance spatial orientation, surgical planning, simulation training, clinical reasoning, and critical thinking of healthcare providers. Patients and parents showed better comprehension and confidence in explaining their condition to others. Despite the cost and technical limitations, 3D models of CHD show promising potential. Integrating 3D heart models into CHD education has positively impacted knowledge acquisition, satisfaction, and confidence across various learner populations. The interactive and tangible nature of 3D models offers advantages over traditional teaching methods, fostering a deeper understanding of complex cardiac structures and pathology. However, further research is necessary to investigate long-term benefits and develop effective integration strategies in medical curricula and practice.

Introduction: Congenital heart disease (CHD) is a common heart defect that can be present in small and large animals at birth. Student understanding of normal and abnormal cardiac anatomy is imperative for proper diagnosis and management of CHD. Objectives were to create and use three-dimensional (3D) heart models during a workshop to understand veterinary student perception of 3D models for CHD education. We hypothesized that 3D models would enhance student understanding of CHD, and students would prefer 3D models during cardiac education. Materials and Methods: Computed tomography angiography datasets from canine patent ductus arteriosus were used to create 3D models. Segmentation and computer-aided design were performed. Virtual overlays of 3D models were displayed onto two-dimensional (2D) thoracic radiographs. Stereolithography files were fabricated by a 3D printer. Students participated in a CHD workshop consisting of 2D and 3D teaching stations. Self-assessment surveys before and after the workshop were completed. Results: Twenty-two veterinary students attended the workshop. The 3D-printed models were found to be the most helpful teaching modality based on students’ perception. The 3D-printed model (P &lt; 0.0001) and the 3D digital model (P &lt; 0.0001) were perceived to be significantly more helpful than the 2D radiograph station. All students strongly agreed (15/22) or agreed (7/22) that virtual models overlayed onto 2D radiographs enhanced their spatial recognition of anatomic structures. All students strongly agreed (17/22) and agreed (5/22) that the CHD workshop was a valuable learning opportunity. Conclusion: Creation of virtual and fabricated 3D heart models is feasible. Three-dimensional models may be helpful when understanding spatial recognition of cardiovascular anatomy on thoracic radiographs. We advocate using 3D heart models during CHD education.

A 20-year-old asymptomatic man was diagnosed with hypertrophic cardiomyopathy (HCM) after routine physical examination during which a systolic heart murmur was detected.Echocardiography showed massive left ventricular (LV) hypertrophy with ventricular septal thickness of 36 mm extending into the anterolateral wall (30 mm); outflow obstruction was absent.Ambulatory (Holter) ECG showed 3 isolated premature ventricular contractions, and blood pressure response to exercise was normal.Echocardiographic examinations in parents and siblings were negative for HCM.Although 2 centers advised against an implantable cardioverter-defibrillator (ICD) based on the presence of only 1 risk factor for sudden death (ie, extreme hypertrophy), a prophylactic device was recommended by a third cardiac consultant.After an uneventful 16-month period during which the ICD neither detected nor treated arrhythmias, an unprovoked episode of ventricular fibrillation triggered a defibrillation shock that immediately restored sinus rhythm (Figure 1).

A industria brasileira, apos intenso processo de crescimento e consolidacao durante seu periodo de industrializacao substitutiva de importacoes (1956-1979), passou a sofrer, dentro de um contexto de mudanca de paradigma produtivo, um constante processo de defasagem quanto a incorporacao de tecnologias a partir dos anos 80. Esse atraso se manifestou tanto na obsolescencia das maquinas e equipamentos, quanto nos modelos administrativos e nas relacoes capital-trabalho, devido principalmente ao Estado, principal fomentador do desenvolvimento da economia e da industria ter perdido a capacidade de realizar politicas industriais (PI) e tecnologicas (PT) que promovessem uma rearticulacao interna das forcas produtivas. Nesse sentido, na presente pesquisa se concentrou a discussao na apresentacao dos determinantes fundamentais do atraso tecnologico da industria brasileira decisivamente a partir dos anos 80, analisando-se, para isso, as condicionantes politicas, economicas e ideologicas, tendo-se como foco as politicas industriais e tecnologicas promovidas pelo Estado brasileiro que, mesmo fomentando um crescimento industrial acelerado da economia com base no paradigma da producao em massa, basicamente prezou pelo desenvolvimento de uma industria voltada para a capacidade produtiva. Nesse sentido, quando se tornou premente uma transicao para o novo paradigma de producao flexivel, esta embasada na geracao de capacidade tecnologica, emergiram inumeras barreiras a essa mudanca. Mesmo a economia tendo buscado desenvolver um nucleo de pesquisa e desenvolvimento e ciencia e tecnologia proprios, esses nao foram suficientemente dinâmicos o bastante a ponto de colocar o pais em movimentos de catching up tecnologico constante como ocorria nos paises mais desenvolvidos, buscando-se direcionar o desenvolvimento da economia para o novo paradigma produtivo. De outro lado, quanto as PI e PT adotadas no desenvolvimento da Coreia do Sul, o fomento do processo de catching up produtivo e tecnologico possibilitou a esse pais absorver de forma dinâmica a “janela de oportunidade” que se abriu com o surgimento do novo paradigma, possibilitando ao pais, que teve um processo de industrializacao tardia como o Brasil, desenvolvesse uma das principais industrias do mundo no que tange a geracao de produtos intensivos em alta tecnologia, votados ao mercado internacional, levando a economia coreana a se situar proximo ou sobre a fronteira tecnologica em expansao do novo paradigma. Assim, o estudo parte do referencial teorico da abordagem schumpeteriana a fim apontar alguns dos elementos que levaram a estrutura industrial brasileira a se conformar com um dinamismo relativamente lento no seu processo de desenvolvimento tecnologico formando uma estrutura com pouca competitividade nos setores mais dinâmicos da industria, os de alta tecnologia e que representam, atualmente o segmento chave da competicao empresarial internacional. Este cenario contrasta com o caso oposto da Coreia do Sul onde esse setor da economia, atualmente, se mostra bastante dinâmico em termos de geracao e disseminacao das inovacoes tecnologicas.

A High-Fidelity Three-Dimensional Computational Model of a Patient with Hypertrophic Cardiomyopathy

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Japan Organization of Occupational Health and Safety onbehalf J3D Introduction Improvements in cardiovascular imaging have contributed to the accurate diagnosis and treatment of cardiovascular diseases. In recent years, we can find a new demand from surgical departments, i.e., 3D heart models of patients for preoperative simulations. However, a 3D surgical model needs a detailed segmentation of heart structures from clinical images because these details are essential for achieving accurate polygon data of an exact 3D model. Thus, in most cases, manual segmentation is required for complicated heart shapes such as the chamber wall, valves, and papillary muscles, which causes a prolonged duration time. Purpose We aim to achieve an automated heart segmentation using a convolutional neural network (CNN) trained using deep learning techniques for the rapid creation of 3D surgical heart models of individual patients. Methods We constructed our original CNN program based on the latest artificial intelligence techniques and trained it to extract shapes of the heart from cardiac computed tomography (CT) images. The training data was 361 slices selected from CT scans of 10 patients. We used data augmentation to increase the amount and diversity of the data into 24,052 slices. The training result with the best Intersection over Union (IoU), one of the evaluation metrics used in deep learning, was saved. Finally, we used the best-trained CNN to construct 3D polygon data of two surgical cases of hypertrophic obstructive cardiomyopathy (HOCM) for preoperative assessments. Results The IoU attained 0.85 after deep learning. The time required to complete the 3D polygon data for the first HOCM case was 5 minutes for segmentation by the trained CNN and 3 hours for data correction by a human operator. Similarly, the time required for the second case was 5 minutes for segmentation without manual correction. We had to correct the segmentation for the first case because we needed an exact 3D model for the preoperative assessment (Fig. 1). According to our records of the other eight 3D heart models in the lab, the work for a 3D polygon shape from CT images needs a median 30 hours (quartiles 23-50 hours) when the procedure is fully manual and non-continuous with breaks in between. Conclusion The CNN-based segmentation aided the constructing heart shapes from cardiac CT images of preoperative patients. Although the performance, reaching IoU of 0.85, was insufficient for fully automatic segmentation, the methodology can shorten the process duration from several hours to several minutes for detailed segmentation of heart structures. We previously applied the CNN-based segmentation to the aorta, aortic stenosis valves, and atheromatous plaque in clinical images, demonstrating adequate segmentation performance. The proposed methodology can be applied as a fundamental technology of cardiovascular imaging for obtaining the actual structures of a target object as 3D coordinate values or a 3D model within a reasonable duration time. Abstract Figure 1

Hypertrophic Subaortic Stenosis in the “Real World”

Here we present the electrodynamical analyses of microwave pulses propagation in a 3D anisotropic heart model for the flrst time. The electrodynamical rigorous solution of Maxwell's equations related to the microwave pulse propagation in the 3D heart model with anisotropic and isotropic media is presented here. The myocardium tissue media is an anisotropic lossy media and blood is an isotropic lossy media. The boundary problem was solved by using the singular integral equations' (SIE) method. Our solution, obtained by the SIE method, is electrodynamically rigorous. The false roots do not appear and the boundary conditions have to be satisfled only on the surfaces dividing difierent materials. The frequency of the carrier microwave is 2.45GHz. The modulating signals are triangular video pulses with the on-ofi time ratio equal to 5 and 100. The pulse durations were always equal to 20s. Microwave electric fleld distributions were analysed at three longitudinal cross-sections of the heart model. The distributions of electric fleld for the anisotropic and isotropic heart models are compared here. 1. INTRODUCTION A human heart may be under in∞uence of the microwave radiation for the medical examination of patients (1) or because of hazardous environment (2). The tissue of a heart, in the normal state possesses anisotropic properties; however, the anisotropy of heart tissue grows with some illnesses (3,4). Desiring to diagnose diseases of heart with the help of the microwave equipment it is necessary to investigate the process of microwave interaction with the anisotropic heart tissue. Research data of the anisotropic properties of heart tissue along and across of myocardium muscle flbers are given in (3). An electrodynamical analysis of the difiraction problem relating to scattering of the pulse- modulated microwave on the anisotropic heart model is given in this article. We solve this problem, using the SIE method (5). In our case the model of heart contains both isotropic and anisotropic area. The model that contains simultaneously anisotropic and isotropic media we will call an anisotropic model. The model that contains only isotropic media we will call an isotropic model.

We present a case of a double-chambered right ventricle in adulthood, in which we tried a detailed morphological assessment and preoperative simulation using 3-dimensional (3D) heart models for improved surgical planning. Polygonal object data for the heart were constructed from computed tomography images of this patient, and transferred to a desktop 3D printer to print out models in actual size. Medical staff completed all of the work processes. Because the 3D heart models were examined by hand, observed from various viewpoints and measured by callipers with ease, we were able to create an image of the complete form of the heart. The anatomical structure of an anomalous bundle was clearly observed, and surgical approaches to the lesion were simulated accurately. During surgery, we used an incision on the pulmonary infundibulum and resected three muscular components of the stenosis. The similarity between the models and the actual heart was excellent. As a result, the operation for this rare defect was performed safely and successfully. We concluded that the custom-made model was useful for morphological analysis and preoperative simulation.

Idiopathic hypertrophic subaortic stenosis (IHSS) is a disease characterized by marked hypertrophy of the left ventricle, involving in particular the interventricular septum and the left ventricula...

To investigate the importance of transthyretin (TTR) gene mutations in explaining the phenotypic expression in patients diagnosed with hypertrophic cardiomyopathy (HCM) in northern Sweden. Hypertrophic cardiomyopathy is relatively common and often caused by mutations in sarcomeric protein genes. Mutations in the TTR gene are also common, one of which causes familial amyloid polyneuropathy (FAP), with peripheral polyneuropathy and frequently, cardiac hypertrophy. These circumstances were highlighted by the finding of an index case with amyloidosis, presenting itself as HCM. Initial rectal and fat biopsies did not show amyloid deposits. Later on, the patient was shown to carry a TTR gene mutation, and cardiac amyloidosis was confirmed by myocardial biopsy. Only then was a repeated fat biopsy positive for amyloid deposits. Cross-sectional study. Cardiology tertiary referral centre. Forty-six unrelated individuals with HCM and the index case were included. Common diagnostic criteria for HCM were used. The 46 patients with HCM were previously analysed for mutations in eight sarcomeric protein genes and the TTR gene was now analysed by denaturing high-performance liquid chromatography and direct sequencing. One mutation in the TTR gene (Val30Met) was found in three individuals and the index case. Three of the 46 cases with HCM carried the Val30Met mutation, and were considered likely to have cardiac amyloidosis, like the index case. As a correct diagnosis of cardiac amyloidosis is mandatory for a potentially life-saving treatment, TTR mutation analysis should be considered in cases of HCM not explained by mutations in sarcomeric protein genes.

Mitral valve abnormalities in decedents of sudden cardiac death due to hypertrophic cardiomyopathy and idiopathic left ventricular hypertrophy.

A High-Resolution Virtual Reality-Based Simulator to Enhance Perioperative Echocardiography Training

The goal of this study was to investigate the role of left ventricular outflow tract obstruction and myocardial hypertrophy on autonomic cardiac function in patients with hypertrophic cardiomyopathy. The sympatho-vagal function was evaluated by spectral analysis of heart rate variability in 28 patients with hypertrophic obstructive cardiomyopathy, 22 patients with hypertrophic non-obstructive cardiomyopathy, 12 with systemic hypertension and left ventricular hypertrophy and 28 healthy subjects. Left ventricular out-flow tract pressure gradient in patients with hypertrophic cardiomyopathy was evaluated by echo-Doppler methods and the quantitative assessment of left ventricular hypertrophy was based on an echocardiographic index. At rest, patients with hypertrophic non-obstructive cardiomyopathy showed normal spectral patterns, while in patients with hypertrophic obstructive cardiomyopathy and in patients with systemic hypertension we observed, respectively, a significant reduction and increase in the low frequency component relative to the control (P < 0.05). During tilt, the physiological increases in the low frequency component and in the low to high frequency ratio were markedly blunted, or even reverted, only in patients with hypertrophic obstructive cardiomyopathy. In these patients, the heart rate increase during tilt was delayed in comparison to the other groups. Finally, in the hypertrophic obstructive cardiomyopathy group, the impairment of sympathetic activation (lack of increase in the low frequency component during tilt) was significantly correlated to the echocardiographic index of left ventricular hypertrophy (r = -0.800, P < 0.001) rather than to the left ventricular outflow tract pressure gradient (r = 0.295, P: ns). Among patients with hypertrophic cardiomyopathy, only those with outflow tract obstruction show spectral signs of altered autonomic cardiac control. Within this group, the autonomic dysfunction appears to be correlated to myocardial hypertrophy rather than to left ventricular outflow tract obstruction.