Cardiac Volume Reduction Research Articles

Cardiac volume reduction during radiotherapy in patients with esophageal carcinoma

Cardiac volume reduction during radiotherapy in patients with esophageal carcinoma

The potential overdose of heart and left anterior descending coronary artery region during intensity-modulated radiation therapy in patients with esophageal cancer.

This study aimed to investigate the changes in dose distribution in the heart and left anterior descending coronary artery region (LADR) during intensity-modulated radiation therapy (IMRT) in patients with esophageal cancer (EC) treated at our institution. The heart and LADR were delineated on the initial and off-cord boost planning computed tomography (CT) images. Cardiac volume reduction (CVR) was defined as the reduction in cardiac volume between the initial CT and off-cord boost CT at the dose of 36Gy irradiated. The involved field IMRT plan was created based on each initial and off-cord boost CT image and was analyzed based on the relationship between CVR and heart and LADR dose-volume parameters (Heart-Dmax, Heart-Dmean, Heart-V20, Heart-V30, Heart-V40, LADR-Dmax, LADR-Dmean, LADR-V15 and LADR-V30). Forty patients with EC were investigated between January 2016 and January 2022. The median CVR ratio during radiation therapy (RT) was 5.57% (range, -7.79 to 18.26%). Simple linear regression analysis revealed significant correlations between CVR during RT and changes in the heart and LADR dose-volume parameters. Some patients (>10%) experienced severe changes in the heart and LADR dose distribution. In three cases with reduced heart volume and primary tumor mass, the changes in LADR-V15 and LADR-V30 showed outliers. In conclusion, CVR during RT correlated with an increase in the heart and LADR dose. When both CVR and tumor volume reduction are large, a potential overdose of LADR during RT should be noted in the IMRT era.

A Case of Pleuritis Due to Left Ventricular Aneurysm in the Legion of Overlapping Cardiac Volume Reduction Operation

A Case of Pleuritis Due to Left Ventricular Aneurysm in the Legion of Overlapping Cardiac Volume Reduction Operation

Reduction in cardiac volume during chemoradiotherapy for patients with esophageal cancer

We investigated the change in cardiac volume over the course of chemoradiotherapy in 26 patients treated for esophageal cancer, using cone beam CT imaging. The cardiac volume reduced significantly, with a median reduction of 8%. A significant relationship with planned cardiac dose was not found.

Reduction in Cardiac Volume During Chemoradiation Therapy for Patients With Esophageal Cancer: Magnitude and Possible Implications for Adaptive Radiation Therapy

Reduction in Cardiac Volume During Chemoradiation Therapy for Patients With Esophageal Cancer: Magnitude and Possible Implications for Adaptive Radiation Therapy

PD-0273: Cardiac volume reduction during chemo-radiotherapy of oesophageal cancer patients

PD-0273: Cardiac volume reduction during chemo-radiotherapy of oesophageal cancer patients

Evaluation of Dose Reduction of Cardiac Exposure Using Deep-inspiration Breath Hold Technique in Left-sided Breast Radiotherapy

Breast cancer is the leading cause of cancer death in women worldwide and the number of women breast cancer patient was increased continuously. Most of breast cancer patie nt has suffered from unnecessary radiation exposure to heart, lung. Low radiation dose to the heart could lead to the worsening of preexisting cardiovascular lesions caused by radiation induced pneumonitis. Also, several statistical reports demonstrated that left-sided breast cancer patient showed higher mortality than right-sided breast cancer patient because of heart disease. In radiation therapy, Deep Inspiration Breath Hold (DIBH) technique which the patient takes a deep inspiration and holds during treatment and could move the heart away from the chest wall and lung, has showed to lead to reduction in cardiac volume and to minimize the unnecessary radiation exposure to heart during treatment. In this study, we investigated the displacement of heart using DIBH CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Treatment planning was performed on the computed tomography (CT) datasets of 10 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ≥95% of the prescribed dose and that the volume inside the CTV receiving >107% of the prescribed dose should be minimized. Scar boost irradiation was not performed in this study. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. The present study demonstrates that cardiac dose during left-sided breast radiotherapy can be reduced by applying DIBH breathing control technique.

Papillary muscle sling and overlapping cardiac volume reduction with aortic valve replacement for valvular cardiomyopathy

A 63-year-old male was admitted to our hospital because of severe aortic regurgitation. The left ventricle was extremely dilated and mild functional mitral regurgitation was detected because of outward displacement of papillary muscles. We used a papillary muscle sling with aortic valve replacement to correct the widened distance between the papillary muscles. A papillary muscle sling when used for reducing tethering at the mitral valve also reduces the posterior left ventricular volume. As well, a transmural longitudinal incision along the left anterior descending artery in the left ventricular free wall was sutured by an overlapping method to reduce the anterior left ventricular volume. The combination of papillary muscle sling and the overlapping method does not need any resection of the cardiac muscle and so would be beneficial for end-stage valvular cardiomyopathy.

Early results of 12 cases of overlapping cardiac volume reduction (OLCVR)—geometric & clinical outcomes

Early results of 12 cases of overlapping cardiac volume reduction (OLCVR)—geometric & clinical outcomes

A Surgical Approach to Severe Congestive Heart Failure-Overlapping Ventriculoplasty

Previously we developed a new procedure of overlapping cardiac volume reduction (OLCVR) surgery for patients with dilated cardiomyopathy refractory to medical treatment. Papillary muscle plication (PMP) when combined with OLCVR may achieve a better clinical outcome. To investigate the early and intermediate results of OLCVR with or without PMP. Twenty-five patients (21 males, 4 females, aged 60 +/- 13 years) with either ischemic (n = 7) or nonischemic (n = 18) dilated cardiomyopathy underwent either isolated OLCVR (n = 11; Original Group) or PMP combined with OLCVR (n = 14; Integrated Group). Early deaths occurred in two (8%) from a noncardiac cause and late deaths in six, two from a cardiac and four from a noncardiac cause. Postoperative data in survivors were significantly improved in terms of NYHA functional class (from 3.6 +/- 1.9 to 1.6 +/- 1.1), ejection fraction (from 18 +/- 6% to 31 +/- 8%), left ventricular diastolic dimension (from 73 +/- 9 to 65 +/- 6 mm), and left ventricular end-diastolic volume index (from 194 +/- 81 to 128 +/- 43 mL/m2) (p < 0.05) in selected comparative cases. One-year crude and cause-specific survivals were 70.9% and 83.1%, respectively, at a mean follow-up of 12.8 months. One-year crude survival of the Integrated and Original Group was 85.7% and 55.6%, respectively (p = 0.24). Although limitations exist in evaluating operative results, we consider OLCVR to be a relatively safe and effective procedure for selected patients with dilated cardiomyopathy. The addition of PMP to OLCVR may enhance the elliptic formation of left ventricle shape and improve mitral valve tethering, but further study is mandatory.

Experimental study of a new operative procedure for nonischemic dilated cardiomyopathy: overlapping cardiac volume reduction operation.

To assess a newly devised procedure for cardiac volume reduction without resecting any cardiac muscle and evaluate its effectiveness in an experimental settings. Ten beagle dogs underwent a rapid pacing leading to heart failure for 3 weeks and then underwent left ventricular reduction by a procedure called the overlapping cardiac volume reduction operation (OLCVR), which consisted of a longitudinal incision in the left ventricular (LV) free wall, sutures from the left margin to the septal wall, and the right margin to the LV free wall. A slope of the linear preload recruitable stroke work relationship ( M(w)), with an X-intercept ( V(o)) were calculated as precise indicators of the LV systolic function. The constant of isovolumic pressure decay (Tau) and the peak filling rate (PFR) were also calculated as indicators of the LV diastolic function. The LV end-diastolic dimensions significantly decreased by OLCVR (43 +/- 2 to 25 +/- 1 mm). Fractional shortening significantly improved by OLCVR (11% +/- 2% to 30% +/- 4%). M(w) (erg. cm(-3). 10(3)) also significantly improved (21 +/- 2 to 33 +/- 3 ( P < 0.001)), whereas V(o), Tau, and PFR did not show any significant changes. The OLCVR significantly increased the early LV systolic function without any detrimental effects on the diastolic function. This procedure may therefore be a useful therapeutic option for end-stage cardiomyopathy.

Overlapping cardiac volume reduction operation

J Thorac Cardiovasc Surg 2002;124:395-7

Partial left ventriculectomy and limited heart transplantation availability.

Partial left ventriculectomy, a novel cardiac volume reduction operation, is applied in countries without a developed heart transplantation program. We sought to determine its impact in our population of patients. Partial left ventriculectomy was performed in 38 patients during the last 4 years. Basic inclusion criteria were nonischemic dilated cardiomyopathy and poor response to medical therapy for heart failure. Hemodynamic evaluation was carried out before and after operation. A modified surgical technique of mitral valve repair and ventricle suturing was applied. Thirty-day, 6-month, and 2-year survival rates were 82% +/- 7%, 65% +/- 8%, and 61% +/- 9%, respectively. Duration of heart failure symptoms was the only predictor of survival (p = 0.042). A high proportion of noncardiac causes of death was noted. Functional capacity in surviving patients improved at every successive measurement up to 1 year postoperatively. The introduction of partial left ventriculectomy in a country with limited heart transplantation availability had a great impact on the management of end-stage heart failure and may represent the only surgical option for some patients. The average cost per patient was substantially lower when compared to heart transplantation.

Symposium on Cardiac Volume Reduction, Part I

Journal of Cardiac SurgeryVolume 16, Issue 1 p. 2-2 Symposium on Cardiac Volume Reduction, Part I Yasunaru Kawashima M.D., Corresponding Author Yasunaru Kawashima M.D.Address for correspondence: Yasumaru Kawashima, M.D., National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565–8565, Japan. Fax: 81–6-6872-7486.Search for more papers by this author Yasunaru Kawashima M.D., Corresponding Author Yasunaru Kawashima M.D.Address for correspondence: Yasumaru Kawashima, M.D., National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565–8565, Japan. Fax: 81–6-6872-7486.Search for more papers by this author First published: 26 July 2007 https://doi.org/10.1111/j.1540-8191.2001.tb00475.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume16, Issue1January 2001Pages 2-2 RelatedInformation

Reduction of cardiac volume in left-breast treatment fields by respiratory maneuvers: a CT study

Purpose: A previous study of healthy female volunteers suggested that deep inspiratory breath holding can reduce the cardiac volume in the treatment portals for left-breast cancer treatment. The reduction of irradiated cardiac volume may be important considering the reported late cardiac morbidity and mortality and the frequent coexistent use of potentially cardiotoxic chemotherapy in breast cancer patients. In the present study, we evaluated the heart volume in the fields and, thus, the true benefit of this respiratory maneuver in breast cancer patients undergoing CT simulation. Materials and Methods: Fifteen patients (median age, 53) were studied. For each patient, CT scans were performed both when the patient breathed normally (quiet respiration) and when the patient held her breath after a deep inspiration. Tangential fields were planned using the same medial, lateral, superior, and inferior borders on skin for the normal breathing and the breath-holding configurations. The cardiac and left-lung volumes within the tangential fields were calculated for both breathing configurations. Multiple scan series were performed for the breath-holding configuration to provide a more accurate delineation of the cardiac tissue and to study the reproducibility of the patient’s position between different cycles of deep inspiration. Results: None of the patients had difficulty holding her breath for 20 s. The cardiac volume in the field was reduced (−86 ± 24%; p < 0.001) when patients held their breath after a deep inspiration compared to when breathing normally. For 7 patients (47%), deep inspiration moved the heart completely out of the radiation fields. The expansion of the lung tissue due to deep inspiration also increased the absolute lung volume in the tangential fields (183 cm 3 vs 97 cm 3, p < 0.001). However, the fractional volume of the left lung in the field was essentially unchanged. For all but 1 patient, the maximum difference between the external body contours from different breath holding cycles was 5 mm and occurred at the lateral aspect of the breast. At the medial aspect, as indicated by the position of the midline marker, the variations were well within the currently accepted tolerance for patient positioning during tangential treatment. Conclusions: Deep-inspiration breath holding substantially reduces cardiac volume in the tangential fields for left-sided breast cancer treatment. The variation between patient positions at different cycles of breath holding was found to be reasonably small. Therefore, it appears feasible to reduce cardiac radiation by treating patients with intratreatment minifractions lasting 10–15 s while patients hold their breath.

The Batista operation in patients with dilated cardiomyopathy.

Between December 1996 and October 1998, 34 patients with nonischemic dilated cardiomyopathy (DCM) received cardiac volume reduction surgery. The patients' ages ranged from 14 to 67 years (mean = 48 years) and included 28 males and 6 females. Associated mitral regurgitation was present in 31 patients, tricuspid regurgitation in 19 patients, and aortic regurgitation in 4 patients. We performed a partial left ventriculectomy (PLV) using antegrade intermittent warm blood cardioplegia in 15 patients (group A), and in 19 patients (group B) PLV was performed using the on-pump beating heart technique. In group A, the mean aortic clamping time was 79+/-33 minutes and the total cardiopulmonary bypass time was 155+/-58 minutes. In group B the mean cardiopulmonary bypass time was 121+/-43 minutes. There were eight hospital deaths (five in group A and three in group B). Five of 10 survivors of group A required inotropic support for 13.8+/-25.3 days after the operation, while 5 of 12 survivors in group B required inotropes for 4.2+/-3.1 days. Hospital mortality was 86% in 7 emergent cases and 7% in 27 elective cases. Echocardiographic study showed that the left ventricular ejection fraction improved from a mean of 18.7% to 30.3% and the left ventricular diameter decreased from a mean of 80.2 mm to 62.3 mm after the operation. All 26 hospital survivors were followed for 1 to 20 months. Three patients died at early follow-up because of congestive heart failure, thrombosed valve, and hepatic failure, respectively. Nineteen patients were in New York Heart Association (NYHA) Class I or II and four were in NYHA Class III. In conclusion, cardiac volume reduction surgery is effective when the operative technique and proper judgment of patient selection are established, and emergent operation is avoided.

Reduction of cardiac volume in left-breast treatment fields by respiratory maneuvers: A CT study

Reduction of cardiac volume in left-breast treatment fields by respiratory maneuvers: A CT study

Effects of Stenting of Recent or Chronic Coronary Occlusions on Late Vessel Patency and Left Ventricular Function

Due to high rates of late vessel reocclusion, balloon angioplasty of recent or chronic coronary occlusions is not associated with a sustained improvement in left ventricular function. Recent studies have suggested that stent implantation at coronary occlusions significantly reduces late vessel occlusion. We thus designed a study to analyze the effect of stent implantation at coronary occlusions on late vessel patency and left ventricular function. Twenty-four consecutive patients with recent or chronic coronary occlusions had successful stent implantation and were enrolled in a 6-month angiographic follow-up program. Contrast left ventricular cineangiography, at baseline and 6-month follow-up, as well as preprocedural, postprocedural, and follow-up angiograms analyzed with quantitative angiography were available in 22 of the patients (92%). At follow-up, no vessel reocclusion was observed and 32% of the patients, as analyzed by the >50% diameter stenosis criterion, had restenosis. There was a significant improvement in global left ventricular function with a decrease in both left ventricular end-diastolic volume index (LVEDVI, p <0.01) and left ventricular end-systolic volume index (LVESVI, p <0.0001) and an increase in left ventricular ejection fraction (LVEF, p <0.0001). Similarly, regional wall motion in the territory of the recanalized artery was also significantly improved (p <0.05). These effects were associated with a reduction in left ventricular filling pressure (p <0.0001). Stent implantation following balloon angioplasty of recent or chronic coronary occlusion is associated with a low rate of late vessel reocclusion, a reduction in cardiac volume, and an increase in ejection fraction. Such effects on left ventricular volumes could have a significant impact on patient survival.

Acute pericardial distension in pigs: effect of fluid conductance on body surface electrocardiogram QRS size.

Pericardial effusion has long been associated with low voltage of the surface electrocardiogram and its clinical utility is well known. The cause of this reduced QRS voltage has usually been attributed to short circuiting of the impulses by the pericardial fluid, but its precise mechanism has not been clearly elucidated. Therefore, we investigated this phenomenon by instilling various fluids with different resistances in increasing volumes into the pericardial space to finally produce acute cardiac tamponade. Acute cardiac tamponade was produced 65 times in 25 closed chest pigs with a mean weight of 57(SEM 1.2) kg. A sufficient quantity (mean = 200 ml) of plasma, saline, blood, and blood with varying packed cell volume was introduced into the pericardial space in 60 ml increments to decrease systemic and pulmonary pressures to 50% of control to produce cardiac tamponade. At that point intrapericardial pressure had increased to 15-20 mm Hg. Resistivity values for the instilled fluids are 150 omega-cm for blood, 60 omega-cm for plasma, and 50 omega-cm for saline. Mean limb and precordial lead QRS voltage fell significantly, with no significant differences among these fluids. Electrocardiograph recordings from a unipolar electrode catheter in the right ventricle showed an increase in R wave voltage, but body surface recordings of stimuli introduced into the right atrium via a bipolar electrode catheter showed no amplitude change. In considering possibilities such as internal shunting of cardiac currents by intrapericardial fluid, distance of the heart from body surface electrodes, and change in cardiac position, the results are best explained by a reduction of cardiac volume and size during cardiac tamponade. This conclusion confirms Brody's hypothesis.

Hypoplasia of the lung and heart in fetal rats with diaphragmatic hernia.

We studied 11 fetal rats with normal heart and diaphragmatic hernia induced by administration of bis-diamine (200 mg) on the 9th and 10th day of pregnancy. After rapid whole-body freezing on the 21st day, the fetuses were studied by means of serial cross-sectional photographs of the frozen thorax. In the fetuses with hernia, the left half of the diaphragm was completely absent, and the liver and stomach were in the left hemithorax. The lung and heart were hypoplastic in fetal diaphragmatic hernia. Cardiac volume reduction involved all four chambers and was more prominent in the left atrium and ventricles. The great vessels were also smaller.