3-dimensional Area Research Articles

Comparative analysis on vapor cloud dispersion between LNG/liquid NH3 leakage on the ship to ship bunkering for establishing safety zones

This study presents a comparative analysis of vapor cloud dispersion in the case of accidental fuel release from a bunkering hose to enable the establishment of a safety zone during the bunkering process. The pipeline can carry marine fuels such as liquefied natural gas (LNG) or liquid ammonia (NH3). The safety zone can be regarded as the 3-dimensional area wherein the leak event takes place and where, under certain circumstances, there is a recognized potential to endanger crew members or damage equipment. The primary objective of this research was to investigate the characteristics of leakage dispersion and determine the safety distance during ship-to-ship LNG or NH3 bunkering. Mathematical models discussing the dispersion process for LNG/NH3 leakage during ship-to-ship bunkering are presented. Numerical studies were conducted for 26 scenarios, considering diverse operational and environmental conditions, leak hole diameters, leak rates, wind speeds, and wind directions. Findings suggest that under equivalent operational conditions, NH3 exhibited a greater dispersion range for the vapor cloud compared to LNG. Consequently, NH3 demands a more extensive safety zone distance. The dispersion time of NH3 was longer than that of LNG. The parametric study revealed that the toxicity and flammability limit range were important parameters that affect the extent of safety zones. In addition, weather conditions (wind speed and wind direction) and leak characteristics (leak rate and leak duration) are critical parameters. The data and insights regarding the prediction of danger areas can serve as a vital reference for both qualitative and quantitative risk assessments concerning emergency management in ship-to-ship LNG/NH3 leakage incidents.

Rekonstruksi Konstitusi Terkait Konsep Wilayah Yang Utuh Dalam Negara Kesatuan Republik Indonesia

Territory is an important attribute for a country, because it relates directly to aspects of sovereignty. In Indonesia, territory is regulated in Article 25A of the 1945 Constitution of the Republic of Indonesia and Article 33 paragraph (3) of the 1945 Constitution of the Republic of Indonesia which regulates state control over natural resources in the form of earth, water and the wealth contained therein. However, both of them do not reflect the concept of a complete territory or a 3-dimensional area, namely land, sea and air. Even though it is so important to regulate the territory and complete spatial planning, this is to provide certainty for the state in applying the boundaries of its territorial territory to maintain state sovereignty and protect all the potential of its natural resources.

3D PED BURN app: A precise and easy-to-use pediatric 3D burn surface area calculation tool.

Background and aimsCalculating the precise total burn surface area is crucial when treating burn patients, particularly children. The Lund and Browder chart and Rule of Nines, 2‐dimensional diagrams that are widely used, are subject to high interrater variance, and they can severely overestimate the burn area. Previously, the adult 3‐dimensional burn area calculation mobile application was developed. Aiming to improve accuracy, a 3‐dimensional pediatric burn surface area calculation mobile application (“3D PED BURN”) was developed to overcome the limitations of the conventional methods.MethodFifteen 3‐dimensional pediatric burn surface area models based on detailed anthropometric measurements collected from 85 patients were developed and categorized into four age groups: <1 year; 1–4 years; 5–9 years, and 10–15 years. According to their weight and height, the models in each group were fractionated into large, medium, and small body sizes.ResultA precise and easy‐to‐use application was developed based on these data. This application is a promising and more accurate calculation tool for burn surface area in pediatric patients. Its low inter‐rater variance makes it reliable for use by various healthcare personnel.ConclusionThe 3D PED BURN app is a pediatric 3D burn surface area calculation tool that is both accurate and simple to use.

Posterior airways and orthognathic surgery: What really matters for successful long-term results?

Although it is well known that orthognathic surgery modifies the upper airways, it is still unclear which are the determining factors to achieve adequate and predictable results in all the patients regardless of the initial malocclusion type and satisfying all the traditional orthognathic treatment objectives. This study aimed to correlate airway changes with surgical movements and other variables and the planning modalities to better understand how to control airway dimensions with treatment. This study involved 61 patients requiring bimaxillary surgery to correct various dentoskeletal deformities without a history of obstructive sleep apnea syndrome. In all the subjects, the orthosurgical treatment was planned according to the same treatment principles and regardless of the initial airway dimension. The 3-dimensional volume and minimal axial area values generated by cone-beam computed tomography at the preoperative, 3-week, and 1-year postoperative controls were evaluated and correlated with surgical movements and other variables. Although the planning did not consider the initial size of the airways, a significant increase was found for volume and minimal axial area in both the short term (volume, 29.0%; area, 51.2%) and long term (volume, 18.2%; area, 39.8%) with no regard to the type of malocclusion. Only 3 of the variables examined were found to significantly affect the airway: the preoperative dimensions, gender, and the extent of mandibular advancement. These 3 explanatory variables combined can predict the 1-year postoperative volume and minimal area with an accuracy of 71% and 44%, respectively. According to this study, orthosurgical treatment can protect airways from unexpected unfavorable changes and satisfy the other treatment goals regardless of the initial malocclusion as long as the facial deformities are properly addressed for each patient. Furthermore, these results identified 3 main variables that influence postoperative airways dimensions the most. Keeping in mind that the relationship between airway dimensions and obstructive sleep apnea syndrome is not clearly explained, these considerations may prove to be a useful tool to help in preventing and managing this disease. Studies involving larger samples of patients and evaluating more variables are mandatory to better understand the correlation between airways and sleep function.

Cross-Sectional Areas and Volumes Occupied by Implants in Simulated Scaphoid Fractures

This study determined the volume of bone replaced by an implant at the proximal and distal poles of simulated scaphoid fractures. We also measured the cross-sectional area of the implant relative to the cross-sectional area of the scaphoid at 2 different simulated fracture locations. Microcomputed tomograhy scans of 7 cadaveric scaphoids were used to create 3-dimensional models in which transverse proximal pole and midwaist fractures were simulated. The volume occupied by 5 commonly used implants and the cross-sectional area occupied at the surface of the fractures was measured using a computer modeling software. For simulated proximal pole fractures, the implants replaced 1.5%-7.4% of the fracture cross-sectional area and 1.2%-6.4% of the proximal fragment bone volume. For midwaist fractures, the implants replaced 1.5%-6.8% of the fracture cross-sectional area and 1.8%-4.6% of the proximal pole volume. Although the different implant designs replaced different areas and volumes, all these differences were small and below 4%. This study provides data that relate to one aspect of fracture healing, specifically, the surface area occupied by 5 different implants in proximal and midwaist scaphoid fractures as well as the volume of bone replaced by the implant. As opposed to the impression provided by 2-dimensional planar imaging, when studied using a 3-dimensional model, the volume and surface area replaced by an implant represent a minimal percentage of scaphoid bone, suggesting a negligible clinical effect.

Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions

ObjectiveThis retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification. Material and methodsCT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the “defect body” method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis. ResultsA total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures – W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm2 to 6.09 cm2 for orbital floor and from 0.29 cm2 to 5.43 cm2 for medial wall fractures.The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm2, W2(i) = 1.64 cm2, W1(i)2(i) = 3.10 cm2, W1(m) = 1.36 cm2, W2(m) = 1.65 cm2, W1(m)2(m) = 2.98 cm2, W1 (im) = 3.35 cm2, W1 (im) 2(i) = 4.63 cm2, W1 (im)2(m) = 4.06 cm2 and W1 (im)2 (im) = 7.16 cm2. ConclusionThe AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.

A novel point-of-care technique to improve graft uptake in a melanocyte-keratinocyte transplantation procedure for vitiligo of contoured areas such as the external ear

Noncultured epidermal cell suspension (NCECS) is increasingly and widely becoming established as a superior technique in the surgical management of vitiligo. However, the high fluidity of the cell suspension leads to significant runoff of graft from the recipient site, often resulting in poor repigmentation on uneven and curved surfaces. This becomes more challenging in the highly contoured 3-dimensional area of the external ear.

A Review of and Algorithmic Approach to Soft Palate Reconstruction.

The soft palate contributes to deglutition, articulation, and respiration. Current reconstructive techniques focus on restoration of both form and function. The unique challenges of soft palate reconstruction include maintenance of complex upper aerodigestive tract function, with minimal local or donor site morbidity. To review the literature on soft palate reconstruction and present an algorithm on how to approach soft palate defects based on this review. A review of the literature for articles reporting studies on and that described concepts related to soft palate reconstruction was conducted in March 2017. In all, 1804 candidate titles and abstracts were independently reviewed. English-language articles that discussed acquired soft palate defect reconstruction were included. Non-English language studies without available translations, studies on primary soft palate defect reconstruction (ie, cleft palate repair) and primary cleft palate repair, studies in which the soft palate was not the focus of the article, and studies involving animals were excluded. The following observations were made from the review of 92 included articles. Soft palate anatomy is a complex interplay of multiple structures working in a 3-dimensional area. Three of the authors created an initial algorithmic framework based on the selected studies. After this, a round table discussion among 3 authors considered experts was used to refine the algorithm based on their expert opinion. The 4 most important factors were determined to be defect size, defect extension to other subsites, defect thickness, and history of radiotherapy or planned radiotherapy. This algorithm includes both surgical and nonsurgical options. Defects in the soft palate not only affect the size and shape of the organ but, more critically, the function. The reconstructive ladder is used to help maximize the remaining soft palate functional tissue and minimize the effect of nonfunctional implanted tissue. Partial-thickness defects or defects less than one-fourth of the soft palate may not require locoregional tissue transfer. Patients with a history of radiotherapy or defects of up to 75% of the soft palate may require locoregional tissue transfer. Defects greater than 75% of the soft palate, defects that include exposure of the neck vasculature, or defects that include significant portions of the hard palate or adjacent oropharyngeal subsites may require free tissue transfer. Obturation should be considered a second-line option in most cases. Ideal reconstruction of the soft palate relies on a comprehensive understanding of soft palate anatomy, a full consideration of the armamentarium of surgical techniques, consideration for adjacent subsite deficits, and a detailed knowledge of various intrinsic and extrinsic patient factors to optimize speech, swallowing, and airway outcomes. The included algorithm may serve as a useful starting point for the surgeon when considering reconstruction.

New Method of Quantitative Analysis of Hard Exudate Using Optical Coherence Tomography: Application in Diabetic Macular Edema

PurposeIn the present study, the volume of hard exudates (HEs) was quantitatively measured using optical coherence tomography (OCT) and the agreement and correlation with area of HEs in fundus photography were analyzed.MethodsThe medical records of patients with diabetic macular edema who underwent focal laser treatment and were followed up more than 3 months were retrospectively evaluated. An automated customized program designed for measuring HE volume was used. The HEs in each OCT B-scan binary image were measured using 512 × 128 pixels, 6 mm × 6 mm OCT cube scans. The volume was measured by summing the segmented HEs in each 128 B-scan image. The area was measured in 6 mm x 6 mm fundus photography. The volume and area were measured before and 3 months after the treatment. The agreement of increase and decrease in HEs, and the correlation of volume and area of HEs were analyzed.ResultsA total of 35 patients (39 eyes) were included in the study. The volume was significantly reduced from 0.07978 to 0.02565 mm3 at 3 months (p < 0.001). The area was also significantly reduced from 15.35 to 8.60 mm2 at 3 months (p < 0.001). The volume was decreased in 34 eyes and increased in 5 eyes. The area was decreased in 37 eyes and increased in 2 eyes. A significant correlation between volume and area was found (p < 0.001) as well as agreement between increase and decrease in volume and area.ConclusionsIn the 3-dimensional quantitative volumetric analysis, the volume and area of HEs were correlated and the direction of increase and decrease was concordant. Considering the distribution of HEs in multiple layers of the retina, volumetric analysis could be considered a substitute for the analysis of HE area.

Medida tridimensional del área del anillo tricúspide. Un nuevo criterio en la selección de candidatos a anuloplastia

Introduction and objectivesLate functional tricuspid regurgitation after rheumatic left-sided valve surgery is an important predictor of poor prognosis. This study investigated the usefulness and accuracy of 3-dimensional transthoracic echocardiography tricuspid area compared with conventional 2-dimensional diameter (2DD) for assessing significant tricuspid annulus dilatation, providing cutoff values that could be used in clinical practice to improve patient selection for surgery. MethodsWe prospectively included 109 patients with rheumatic heart disease in the absence of previous valve replacement. Tricuspid regurgitation was divided into 3 groups: mild, moderate, and severe. Optimal 3-dimensional area (3DA) and 2DD cutoff points for identification of significant tricuspid annulus dilatation were obtained and compared with current guideline thresholds. Predictive factors for 3DA dilatation were also assessed. ResultsOptimal cutoff points for both absolute and adjusted to body surface area (BSA) tricuspid annulus dilatation were identified (3DA: 10.4 cm2, 6.5 cm2/m2; 2DD: 35 mm, 21 mm/m2); 3DA/BSA had the best diagnostic performance (AUC=0.83). Three-dimensional transthoracic echocardiography tricuspid area helped to reclassify surgical indication in 14% of patients with mild tricuspid regurgitation (95%CI, 1%-15%; P=.03) and 37% with moderate tricuspid regurgitation (95%CI, 22%-37%; P<.0001), whereas 3DA/BSA changed surgery criteria in cases of mild tricuspid regurgitation (17%; 95%CI, 3%-17%; P=.01) compared with 2DD/BSA. On multivariable analysis, right and left atrial volumes and basal right ventricle diameter were independently correlated with 3DA. ConclusionsThe current 40 mm threshold underestimates tricuspid annulus dilatation. Although 21 mm/m2 seems to be a reasonable criterion, the combination with 3DA assessment improves patient selection for surgery.Full English text available from:www.revespcardiol.org/en

Fabrication and evaluation of silica aerogel-epoxy nanocomposites: Fracture and toughening mechanisms

Silica aerogel is a promising candidate for improving the mechanical properties of epoxy-based nanocomposites due to the unique properties such as the 3-dimensional nanoporous structure and high surface area. In this study rheological, mechanical and thermal properties of the silica aerogel-epoxy nanocomposites were investigated. The rheological results demonstrated an increase in viscosity of the nanocomposite suspension compared to the neat resin. The results of dynamic mechanical along with the thermal analysis showed that the addition of 6 wt% of silica aerogel causes the storage modulus and glass transition point (Tg) to be increased by 11% and 5 °C, respectively. Also, significant improvements in the elastic modulus (35%), tensile strength (62%) and toughness (126%) were achieved with the optimal volume fraction of silica aerogel (6 wt%). Two main fracture mechanisms were involved in the fracture behavior of the silica aerogel-epoxy nanocomposite: (a) crack pining and deflection, and (b) plastic deformation (debonding).

Introducing a novel model: The special theory of relativity for attractiveness to define a natural and pleasing outcome following cosmetic treatments.

A meteoric expansion in esthetic medicine followed the introduction of nonsurgical cosmetic neuromodulators and fillers in the early 2000s, which has been recently declining. The initial inertia has likely been tempered by the cosmetically interested patient's fear of appearing unnatural. Defining a natural outcome is a mission essential to the advancement of esthetic medicine; however, achieving a natural result following cosmetic intervention is a misnomer and a logically flawed endeavor that cannot exist. The ever elusive "natural" that is loudly desired by the populous, and ardently pursued by both industry and physicians, can only be an interpreted deduction. To better define a natural outcome, a novel model based on the theory of relativity is suggested. Attractiveness consists of a 3-dimensional area defined by beauty, genuineness, and self-esteem. When all three variables are at a maximum, a desirable attractive appearance is achieved that can be interpreted as "natural." Similar to the time-space dilemma, attractiveness is relative, dynamic, and highly dependent on the position of the projector and the interpreter. The 3D cube of attractiveness is therefore contained within a 4th dimension that takes into account the perspective of the judger. It is hoped that by realizing a new theory of what defines a natural outcome, esthetic medicine will be prepared to meet the needs of future generations.

Three-dimensional Tricuspid Area. A New Criterion to Improve Patient Selection for Annuloplasty in Tricuspid Regurgitation.

Late functional tricuspid regurgitation after rheumatic left-sided valve surgery is an important predictor of poor prognosis. This study investigated the usefulness and accuracy of 3-dimensional transthoracic echocardiography tricuspid area compared with conventional 2-dimensional diameter (2DD) for assessing significant tricuspid annulus dilatation, providing cutoff values that could be used in clinical practice to improve patient selection for surgery. We prospectively included 109 patients with rheumatic heart disease in the absence of previous valve replacement. Tricuspid regurgitation was divided into 3 groups: mild, moderate, and severe. Optimal 3-dimensional area (3DA) and 2DD cutoff points for identification of significant tricuspid annulus dilatation were obtained and compared with current guideline thresholds. Predictive factors for 3DA dilatation were also assessed. Optimal cutoff points for both absolute and adjusted to body surface area (BSA) tricuspid annulus dilatation were identified (3DA: 10.4 cm2, 6.5 cm2/m2; 2DD: 35 mm, 21 mm/m2); 3DA/BSA had the best diagnostic performance (AUC=0.83). Three-dimensional transthoracic echocardiography tricuspid area helped to reclassify surgical indication in 14% of patients with mild tricuspid regurgitation (95%CI, 1%-15%; P=.03) and 37% with moderate tricuspid regurgitation (95%CI, 22%-37%; P<.0001), whereas 3DA/BSA changed surgery criteria in cases of mild tricuspid regurgitation (17%; 95%CI, 3%-17%; P=.01) compared with 2DD/BSA. On multivariable analysis, right and left atrial volumes and basal right ventricle diameter were independently correlated with 3DA. The current 40 mm threshold underestimates tricuspid annulus dilatation. Although 21 mm/m2 seems to be a reasonable criterion, the combination with 3DA assessment improves patient selection for surgery.

Regularity Theory for 2-Dimensional Almost Minimal Currents II: Branched Center Manifold

We construct a branched center manifold in a neighborhood of a singular point of a 2-dimensional integral current which is almost minimizing in a suitable sense. Our construction is the first half of an argument which shows the discreteness of the singular set for the following three classes of 2-dimensional currents: area minimizing in Riemannian manifolds, semicalibrated and spherical cross sections of 3-dimensional area minimizing cones.

Operando Resonant Soft X-Ray Scattering As a Spatio-Chemical Characterization Technique for Electrochemistry

The development of complex mesoscale (nm - µm) materials used for electrochemical applications requires comparable progress in the analytical instruments and techniques in order to understand the physical and chemical structure-property relationships underlying their performance. Conventional “hard” X-ray (i.e. > 10 keV) scattering has received considerable attention due to the fact that it is a high-resolution nondestructive structural probe that can interrogate a statistically significant 3-dimensional sample area. The non-resonant nature of this scattering process limits its applicability to materials that possess significantly different electron densities. Unfortunately, the performance of many electrochemical materials hinges on subtle heterogeneities that do not possess a high electron density contrast such as interfacial nanostructures, impurities, and chemical composition gradients. To help address this challenge, resonant soft X-ray scattering (RSoXS) uses tunable “soft” X-rays (100 - 2000 eV) to dramatically enhance the scattering cross sections from heterogeneous materials when the X-ray photon energy is judiciously chosen to coincide with favored transitions near a material’s absorption edges. The RSoXS results in Fig. 1a show an example of how we used the resonance-enhanced scattering signals at selected photon energies to isolate the scattering contribution from different polymers in a phase separated block copolymer in order to unambiguously define the complex morphology of a triblock copolymer sample with both chemical and nm-scale spatial sensitivity.1 In this presentation, we reveal how operando RSoXS can be a powerful reciprocal space probe for mesoscale electrochemistry due to its chemical sensitivity, large accessible size scale, and polarization control.2, 3 We will convey how this technique can be applied under operando conditions to study pores, surfaces,4 and buried interfaces5 of low-Z element materials6 including many transition metals; the practical considerations of conducting such experiments will also be discussed. We will explain how the intrinsic combination of scattering and spectroscopy allows us to monitor spatio-chemical changes at a specific location by detecting the change in intensity at a specific scattering vector, q , for X-ray energies that are both ON and OFF resonance with the species of interest (Fig. 1b). As an example of the utility of RSoXS to electrochemical applications, we present recent results on Nafion, a perfluorinated sulfonic acid (PFSA) membrane material that is considered to be a critical cost and performance-limiting component in many devices including fuel cells, electrolyzers, and redox-flow batteries. Recent RSoXS results acquired with a wet sample cell interrogated the Nafion films’ partially orientated molecules inside ionomer domains. Using polarized X-rays with a photon energy tuned to the fluorine absorption edge (~690 eV), we observed a surprisingly strong scattering anisotropy that indicated preferred local crystalline grain orientation at the interface between different phases, an effect which is not visible when the X-ray photon energy is off-resonance with the fluorinated ionomers (Fig. 1c). These results enable us to develop a full electron density map that helps us understand why the pore structure of Nafion works so well, but may also yield insights into whether the development of porous separators as alternatives to PFSAs require pore sizes that are comparable to the hydrophilic channels in PFSAs (e.g., ≤ 3 nm).7 We will then expand on how combining such operando RSoXS data with electrochemical analytical methods could uncover important dynamic structure-property relationships underlying the interplay of various factors such as migration and electro-osmosis, chemical/physical stability, water uptake, permeability, etc.8-10

The ACL Graft Has Different Cross-sectional Dimensions Compared With the Native ACL

Background: Impingement of anterior cruciate ligament (ACL) grafts against the femoral notch and the posterior cruciate ligament (PCL) is thought to be influenced primarily by tunnel position and graft orientation. Recent data have implied that the native ACL is ribbon-shaped. Purpose: To evaluate the 3-dimensional shape and cross-sectional area of the native ACL versus the ACL graft and to compare the degree of impingement against the femoral notch and PCL. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Bilateral knee magnetic resonance images were analyzed for 27 patients with unilateral bone–patellar tendon–bone (BPTB) ACL reconstruction performed via transtibial or anteromedial portal femoral tunneling techniques. Three-dimensional models of the ACL, PCL, femur, and tibia were digitally rendered. The cross-sectional area and dimensions of the native ACL and the reconstructed graft were determined at 3 equally spaced locations and compared via Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. In addition, impingement of the ACL on the PCL and femoral notch was graded in 3 groups. Chi-square or Fisher exact tests were used to compare the proportional differences of impingement of the native and reconstructed ACL on the PCL and femoral notch, respectively. All analyses were performed using 2-sided hypothesis testing, with statistical significance at P < .05. Results: Cross-sectional areas at all 3 points on the ACL graft were significantly greater than those of the native ACL (P < .001). The long- to short-axis ratio for the native ACL was significantly greater at each location compared with the corresponding locations along the ACL graft (P < .001), implying that the native ACL is “flatter” than is an ACL graft. There were 19 operated knees (70%) with contact or impingement between the ACL graft and the femoral notch compared with zero knees with a native ACL (P < .001). In addition, 22 operated knees (81%) showed contact or impingement between the ACL graft and the PCL, compared with 7 knees (26%) with a native ACL (P < .001). No significant differences in impingement frequency were noted between the transtibial and anteromedial tunneling techniques for ACL graft specimens (P > .05). Conclusion: Native ACLs have a smaller cross-sectional area, are “flatter,” and experience less incidence of impingement compared with anatomically placed BPTB ACL grafts.

Role of Mitral Leaflet Separation Index (MLSI) in Determining Mitral Stenosis Severity

Objective. To Correlate MLSI with 3-D mitral valve area (MVA) planimetry in determining mitral stenosis (MS) severity.Background. Mitral Stenosis (MS) is still a major problem in cardiology, and causes of morbidity dan mortality worldwide. Echocardiogrphy plays an important role in assessing mitral stenosis severity. Mitral leaflet separation index (MLSI) is one of simple method that can be used in peripheral by using common ultrasound to assess the severity mitral stenosis.Methods. We employed a cross sectional study. Mitral stenosis patients who referred for evaluation echocardiography in National Cardiac Center Harapan Kita from April to September 2011. MLSI was obtained by averaging the maximal leaflet separation distance at the tips in diastole in parasternal long-axis and apical four- chamber views. 3-Dimensional (3-D) mitral valve area (MVA) planimetry as a reference. The only exclusion criteria was severe calcification and poor echo window. Echocardiography examination using Philips E33i.Results. Seventy six consecutive patients were enrolled, 5 subjects were excluded from study because of severe calcification and poor echo window. Proportion of woman is 73.2 % and mostly in age group &lt; 40 years old (43.7 %). Severe mitral stenosis was dominate the subject, 47 subject (66.2 %), moderate was 19 subject (26.8 %), and mild only 5 subjects (7.0 %). Analysis with Spearman correlations obtained a good correlation with r = 0.70, p &lt; 0.001, good correlation was found in sinus rhythm with r = 0.78, p &lt; 0.001 and atrial fibrillation with r = 0.79, p &lt; 0.001. MLSI less than 0.69 cm predicted severe MS with 85 % sensitivity and 82.4 % specificity.Conclusions. Mitral leaflet separation index (MLSI) has a good correlation with 3-D MVA planimetry. MLSI less than 0.69 cm can estimate severe SM.

Influence of White-Coat Hypertension on Left Ventricular Deformation 2- and 3-Dimensional Speckle Tracking Study.

We sought to compare left ventricular deformation in subjects with white-coat hypertension to normotensive and sustained hypertensive patients. This cross-sectional study included 139 untreated subjects who underwent 24-hour ambulatory blood pressure monitoring and completed 2- and 3-dimensional examination. Two-dimensional left ventricular multilayer strain analysis was also performed. White-coat hypertension was diagnosed if clinical blood pressure was elevated and 24-hour blood pressure was normal. Our results showed that left ventricular longitudinal and circumferential strains gradually decreased from normotensive controls across subjects with white-coat hypertension to sustained hypertensive group. Two- and 3-dimensional left ventricular radial strain, as well as 3-dimensional area strain, was not different between groups. Two-dimensional left ventricular longitudinal and circumferential strains of subendocardial and mid-myocardial layers gradually decreased from normotensive control to sustained hypertensive group. Longitudinal and circumferential strains of subepicardial layer did not differ between the observed groups. We concluded that white-coat hypertension significantly affects left ventricular deformation assessed by 2-dimensional traditional strain, multilayer strain, and 3-dimensional strain.

Comparison of Three-Dimensional Proximal Isovelocity Surface Area to Cardiac Magnetic Resonance Imaging for Quantifying Mitral Regurgitation

The aim of our study was to evaluate 3-dimensional (3D) color Doppler proximal isovelocity surface area (PISA) as a tool for quantitative assessment of mitral regurgitation (MR) against in vitro and in vivo reference methods. A customized 3D PISA software was validated in vitro against a flowmeter MR phantom. Sixty consecutive patients, with ≥mild MR of any cause, were recruited and the regurgitant volume (RVol) was measured by 2D PISA, 3D peak PISA, and 3D integrated PISA, using transthoracic (TTE) and transesophageal echocardiography (TEE). Cardiac magnetic resonance imaging (CMR) was used as reference method. Flowmeter RVol was associated with 3D integrated PISA as follows: y = 0.64x + 4.7, r(2) = 0.97, p <0.0001 for TEE and y = 0.88x + 4.07, r(2) = 0.96, p <0.0001 for TTE. The bias and limit of agreement in the Bland-Altman analysis were 6.8 ml [-3.5 to 17.1] for TEE and -0.059 ml [-6.2 to 6.1] for TTE. In vivo, TEE-derived 3D integrated PISA was the most accurate method for MR quantification compared to CMR: r(2) = 0.76, y = 0.95x - 3.95, p <0.0001; 5.1 ml (-14.7 to 26.5). It was superior to TEE 3D peak PISA (r(2) = 0.67, y = 1.00x + 6.20, p <0.0001; -6.3 ml [-33.4 to 21.0]), TEE 2D PISA (r(2) = 0.54, y = 0.76x + 0.18, p <0.0001; 8.4 ml [-20.4 to 37.2]), and TTE-derived measurements. It was also most accurate by receiver operating characteristic analysis (area under the curve 0.99) for the detection of severe MR, RVol cutoff = 48 ml, sensibility 100%, and specificity 96%. RVol and the cutoff to define severe MR were underestimated using the most accurate method. In conclusion, quantitative 3D color Doppler echocardiography of the PISA permits a more accurate MR assessment than conventional techniques and, consequently, should enable an optimized management of patients suffering from MR.

Aortic valve adaptation to aortic root dilatation: insights into the mechanism of functional aortic regurgitation from 3-dimensional cardiac computed tomography.

The 3-dimensional relationship between aortic root and cusp is essential to understand the mechanism of aortic regurgitation (AR) because of aortic root dilatation (ARD). We sought to test the hypothesis that the stretched cusps in ARD enlarge to compensate for ARD. Computed tomography imaged 92 patients (57 with ARD, 29 with moderate to severe AR, 28 without significant AR) and 35 normal controls. Specialized 3-dimensional software measured individual cusp surface areas relative to maximal mid-sinus cross-sectional area and minimal 3-dimensional annular area, coaptation area fraction, and asymmetry of sinus volumes and intercommissural distances. Total open cusp surface area increased (P<0.001) from 7.6±1.4 cm(2)/m(2) in normals to 12.9±2.2 cm(2)/m(2) in AR-negative and 15.2±3.3 cm(2)/m(2) in AR-positive patients. However, the ratio of closed cusp surface area to maximal mid-sinus area, reflecting cusp adaptation, decreased from normals to AR-negative to AR-positive patients (1.38±0.20, 1.15±0.15, 0.88±0.15; P<0.001), creating the lowest coaptation area fraction. Cusp distensibility (closed diastolic versus open area) decreased from 20% in controls and AR-negative patients to 5% in AR-positive patients (P<0.001). Multivariate determinants of AR and coaptation area fraction reflected both sinus size and cusp-to-annular adaptation. ARD was also progressively asymmetrical with root size, and individual cusp surface areas failed to match this asymmetry. Aortic cusp enlargement occurs in ARD, but cusp adaptation and distensibility become limited in prominent, asymmetrical ARD, leading to AR. Optimal AR repair tailored to individual patient anatomy can benefit from appreciating valve adaptation and 3-dimensional relationships; understanding cusp adaptation mechanisms may ultimately provide therapeutic opportunities to improve such compensation.