Ventricular Cavity Research Articles

A Review of the Occurrence of Intraventricular Hemorrhage in Preterm Newborns and its Future Neurodevelopmental Consequences.

Intraventricular hemorrhage (IVH) is a type of bleeding that occurs through the germinal matrix and comes through the ependymal cells into the ventricular cavity. It is mostly seen in preterm neonates but can also be seen sometimes in term neonates. Various factors predispose to preterm delivery; it can be spontaneous or medically induced. Spontaneous IVH occurs in cases of intrauterine infections in the mother, and it can be induced in cases of medical emergencies such as preeclampsia and eclampsia. The brain of a preterm newborn is not fully developed as it does not have pericytes and proteins, so it can bleed very quickly, which can cause IVH. Also, the vessels supplying the germinal matrix are immature and highly vascularized. IVH has four grades based on findings detected on cranial ultrasound and MRI. Management includes medical and surgical management; medical management includes phenobarbitone used for seizures and prophylaxis. Surgical management includes drainage, irrigation, and fibrinolytic therapy (DRIFT), and neuro-endoscopic lavage. IVH causes various short-term and long-term neurodevelopmental consequences. Long-term complications include cerebral palsy and intellectual disability, which hamperthe life of the child. It mainly presents with seizures, flaccidity, decerebrate posture, etc. Various preventive measures can be taken to tackle IVH in newborns. First of all, preterm delivery should be avoided, and intrauterine infections in mothers should be treated. The administration of corticosteroids should be done for all preterm deliveries as it helps in the maturation of organs. The administration of magnesium sulfate should be done as it is neuroprotective and reduces cerebral palsy in the future. Delayed cord clamping is to be done to reduce recurrent blood transfusions and decrease the risk of IVH. This article explains the pathogenesis, management, prevention, and future outcomes of IVH.

Pulmonary Transit Time Derived from First-Pass Perfusion Cardiac MR Imaging: A Potential New Marker for Cardiac Involvement and Prognosis in Light-Chain Amyloidosis.

First-pass perfusion cardiac MR imaging could reflect pulmonary hemodynamics. However, the clinical value of pulmonary transit time (PTT) derived from first-pass perfusion MRI in light-chain (AL) amyloidosis requires further evaluation. To assess the clinical and prognostic value of PTT in patients with AL amyloidosis. Prospective observational study. 226 biopsy-proven systemic AL amyloidosis patients (age 58.62 ± 10.10 years, 135 males) and 43 healthy controls (age 42 ± 16.2 years, 20 males). SSFP cine and phase sensitive inversion recovery late gadolinium enhancement (LGE) sequences, and multislice first-pass myocardial perfusion imaging with a saturation recovery turbo fast low-angle shot (SR-TurboFLASH) pulse sequence at 3.0T. PTT was measured as the time interval between the peaks of right and left ventricular cavity arterial input function curves on first-pass perfusion MR images. Independent-sample t test, Mann-Whitney U test, Chi-square test, Fisher's exact test, analysis of variance, or Kruskal-Wallis test, as appropriate; univariable and multivariable Cox proportional hazards models and Kaplan-Meier curves, area under receiver operating characteristic curve were used to determine statistical significance. PTT could differentiate AL amyloidosis patients with (N = 188) and without (N = 38) cardiac involvement (area under the curve [AUC] = 0.839). During a median follow-up of 35 months, 160 patients (70.8%) demonstrated all-cause mortality. After adjustments for clinical (Hazard ratio [HR] 1.061, confidence interval [CI]: 1.021-1.102), biochemical (HR 1.055, CI: 1.014-1.097), cardiac MRI-derived (HR 1.077, CI: 1.034-1.123), and therapeutic (HR 1.063, CI: 1.024-1.103) factors, PTT predicted mortality independently in patients with AL amyloidosis. Finally, PTT could identify worse outcomes in patients demonstrating New York Heart Association class III, Mayo 2004 stage III, and transmural LGE pattern. PTT may serve as a new imaging predictor of cardiac involvement and prognosis in AL amyloidosis. 2 TECHNICAL EFFICACY: Stage 2.

SURG-31. DEFINING THE NEW POSSIBILITIES FOR CESIUM BRACHYTHERAPY IN PATIENTS WITH PERIVENTRICULAR GBM

Abstract INTRODUCTION Re-irradiation of patients with external beam radiotherapy (EBRT) for recurrent glioblastoma (GBM) continues to present a therapeutic dilemma due to a high risk of radiation induced necrosis (RN). In contrast, brachytherapy represents a safer, more conformal radiation option aimed at optimizing local control while minimizing the risk of brain tissue damage. Immediate intra-operative implantation with brachytherapy prevents tumor repopulation and offers patients two procedures in one setting. However, due to the risk of seed migration, surgical resection and brachytherapy in periventricular regions was deemed unachievable. In heavily pretreated periventricular GBM, where further EBRT is complicated by RN, a barrier between the ventricular lining and tumor cavity is needed to prevent seed migration. We present two patients where such a barrier allowed successful implantation of brachytherapy to improve disease control. METHODS Two patients, previously treated with surgery and EBRT, presented with recurrent GBM abutting the ventricles. Following GTR of the tumors, a barrier was created by patching the ventricle with Gelfoam to prevent seed migration. Intraoperative brachytherapy implantation of suture stranded Cs-131 seeds (Isoray) for patient 1 and collagen embedded Cs-131 (GammaTile) for patient 2 was performed. A total of 20 Cs-131 seeds on strings threaded through Surgicel, and 6 GammaTiles (24 Cs-131 seeds), were used implanted in patients 1 and 2, respectively. Surgicel covered the implanted seeds and the resection cavity filled with Adherus. RESULTS Post-operative CT scan demonstrated all 20 Cs-131 seeds and 24 Cs-131 seeds in the surgical cavities of patients 1 and 2, respectively, and had serial post operative imaging with MRI scans showing Cs-131 seeds layering surgical cavity, as late as 6 months in total follow up. To date, both patients have had durable local control and no seed migration.

Long-term structural right heart remodeling following transcatheter annuloplasty for treating severe tricuspid regurgitation assessed by CT scan

Abstract Background Transcatheter tricuspid annuloplasty has emerged as an attractive percutaneous therapy for patients with severe symptomatic tricuspid regurgitation. Cardioband (Edwards) was the first dedicated CE marked percutaneous device for tricuspid regurgitation. Despite mid-long-term clinical safety and efficacy demonstrated in early feasibility trials and registries, there is no data about its impact on right heart structural remodeling using computed tomography (CT). Our aim was to assess right heart remodeling and changes in the tricuspid annulus (TA) one year after Cardioband implantation. Methods A total of 30 patients were prospectively included in the study; 21 of them had baseline and at least 1-year follow-up CT analysis. The average time from the basal CT scan and the procedure was 118±136 days, and from the intervention to follow-up CT scan was 468±251 days. 2D and 3D analyses were performed with 3mensio version 10.3 at baseline and at least 12 months after Cardioband implantation. Results There was a significant decrease in right ventricular dimensions at follow-up (right ventricular basal diameter was 53.65 ± 8.45 mm at baseline Vs 48.54 ± 9.12 mm at 1-year follow-up; right ventricular mid cavity diameter was 40.30 ± 9.10 mm at baseline Vs 34.22 ± 9.22 at the end of follow-up, and right ventricular longitudinal diameter was 75.43 ± 9.85 mm at baseline Vs 69.95 ± 9.96 mm at the end of follow-up, all of them were statistically significant). A reduction in right atrial dimension was also observed (longitudinal diameter 66.86 ± 7.63 mm at baseline Vs 64.89 ± 9.99 mm at the end of follow-up; transverse diameter of 61.62 ± 8.38 mm at baseline Vs 60.59 ± 8.3 mm at the end of follow-up, p<0.001). There was a significant decrease in the area and diameters of the dilated TA (area at baseline 16.51 ± 3.06 cm2 vs 8.90 ± 2.71 cm2 at the end of follow-up, p=0.02; septolateral diameter 45.42 ± 5.02 mm at baseline vs 33.87 ± 5.09 mm at the end of follow-up, p=0.01). Conclusions Long-term favorable right ventricular chambers and TA remodeling was observed following Cardioband implantation assessed by CT scan. This finding could explain the long-term clinical benefit demonstrated in feasibility studies.Right heart remodeling after Cardioband

Relative size of the effective regurgitant orifice to right ventricular cavity contributes significantly to the underestimation of 2D PISA method in tricuspid regurgitation quantitation

Abstract Background 2D proximal isovelocity surface area (PISA) method underestimates tricuspid regurgitation (TR) severity largely due to the distortion of proximal flow geometry under low jet velocity. Previous studies demonstrated that the confining wall geometry also strained the streamline distribution in the proximal flow field. This could add to the variability when applying 2D PISA in TR as TR presents with wider range of effective regurgitant orifice area (EROA). Purpose We aim to examine (1) the impact of ventricular wall constraint to proximal flow region on TR quantitation and (2) its relative contribution to the underestimation of 2D PISA compared with the distortion of proximal flow field under low jet velocity. Methods 150 pts with more than mild TR underwent comprehensive echocardiographic session. The standard 2D PISA EROA (EROASD)was derived as per guideline with angle correction applied for tethering leaflets. The underetimation caused by low jet velocity was corrected by multiplying the standard EROA (EROASD) with VOrifice/(VOrifice-VNyquist), where the VOrifice stands for the peak regurgitant velocity and the VNyquist represents the color Doppler aliasing velocity (EROAVo-VN). The volumetric EROA and vena contracta area serves as two independent reference methods. The ventricular wall constraint was quantified as the ratio of reference EROA to right ventricular end-diastolic volume (RVEDV). Results A consistent significant underestimation by standard 2D PISA methods, either corrected for low jet velocity or not, was observed as a function of the EROA (Figure 1). In Bland-Altman analysis, correction for low jet velocity lessened the systematic underestimation but still leaves minor while could-be-important error (VCA, bias = 19.6 and 15.1 mm2; volumetric EROA, bias = 10.1 and 5.6 mm2 for EROASD and EROAVo-VN respectively). The accuracy of both methods to differentiate severe TR was similar but the cut-off values were lower compared with guideline recommendation (AUC = 0.905 and 0.903, cut-off = 0.26 and 0.29 cm2 for EROASD and EROAVo-VN respectively). In multi-linear regression model (Table 1), the difference between standard 2D PISA EROA and reference EROA (mean of volumetric EROA and vena contracta area) was significantly related to etiology, the jet velocity-related correction coefficient, and the reference EROA/RVEDV ratio. The ventricular wall constraint contributes to the underestimation of 2D PISA to a greater extent than the low jet velocity (beta = -0.269 and 0.592 for VOrifice/(VOrifice-VNyquist) and reference EROA/RVEDV respectively). Conclusion Correction for low jet velocity lessens the extent of underestimation of TR severity by 2D PISA method but still leaves important measurement error. The confining wall geometry to proximal flow region contributes significantly to the understimation but is not accounted for in current recommendation. This could be especially important in massive and torrential TR.

Shared and distinguishing phenotypic characteristics of filamin c and desmoplakin cardiomyopathy

Abstract Background Rare truncating variants in the genes Filamin C (FLNC) and Desmoplakin (DSP) are increasingly recognised causes of Dilated Cardiomyopathy and Arrhythmogenic Cardiomyopathy (1,2). A direct comparison of both genotypes is needed to aid in subclassification and genotype-specific risk modelling. Purpose We sought to identify shared and distinguishing clinical characteristics and imaging phenotypes between FLNC and DSP cardiomyopathy. Methods 41 patients with ‘pathogenic’ or ‘likely pathogenic’ FLNC or DSP variants by American College of Medical Genetics (ACMG) criteria were identified from a tertiary centre cardiovascular genetics laboratory. Clinical, genetic and imaging data were compiled. Continuous variables are presented as median [IQR] or mean±SD and analysed by nonparametric Mann Whitney U or t-test. Categorical variables were analysed by Chi-Squared or Fisher’s exact test. Results FLNC and DSP cohorts included a similar proportion of patients with truncating variants (91% vs 100%) and female sex (12/21, 57% vs 13/20, 65%). FLNC patients were younger (median age 30 [13-51] vs 57 [41-65] years, p<0.0008) and more likely to present with sustained ventricular arrhythmia (5/21 24% vs 3/20, 15%) (Table 1). Acute myocarditis episodes were exclusively linked to DSP cardiomyopathy (4/20, 20%) with no association to FLNC (0/21, 0%, p<0.05). FLNC cardiomyopathy patients had normal left ventricular (LV) systolic function (LVEF 57±9% SD vs 46±13% DSP, p<0.03) and normal left ventricular cavity side (mean indexed LV end diastolic volume (EDV) 85±12 vs 112±26ml/m2 DSP, p<0.02) (Table 2). Both FLNC and DSP cause exclusive left ventricular or biventricular late gadolinium enhancement (75% Vs 82%) on cardiac magnetic resonance imaging (MRI). Fibrosis was predominantly in a subepicardial distribution in both cohorts (66% FLNC vs 57% DSP). In FLNC, circumferential fibrosis was the most frequent pattern of distribution (5/9, 55%), whereas in DSP inferior and lateral wall fibrosis was the predominant feature (8/14, 57%). There were no cases of isolated RV involvement and no cases fulfilled ‘definite’ ARVC taskforce diagnostic criteria. Over a follow up of median 45months, there was no significant difference in the proportion of FLNC and DSP patients experiencing a composite end point of LVAD implantation, heart transplant, aborted sudden cardiac death or mortality (7/21, 33% FLNC Vs 7/20, 29% DSP p>0.99). Conclusion Normal systolic function with marked circumferential fibrosis is the predominant feature of FLNC cardiomyopathy whereas mild LV dilatation, mild systolic impairment and inferolateral fibrosis are more frequent in DSP cardiomyopathy. Myocarditis episodes are a distinguishing feature of DSP cardiomyopathy, suggesting a different underlying molecular mechanism driven by inflammation. The overall clinical trajectory of FLNC and DSP cardiomyopathy patients are comparable.

Image Characteristics of Virtual Non-Contrast Series Derived from Photon-Counting Detector Coronary CT Angiography-Prerequisites for and Feasibility of Calcium Quantification.

In photon-counting detector CT (PCD-CT), coronary artery calcium scoring (CACS) can be performed using virtual non-contrast (VNC) series derived from coronary CT angiography (CCTA) datasets. Our study analyzed image characteristics of VNC series in terms of the efficacy of virtual iodine "removal" and image noise to determine whether the prerequisites for calcium quantification were satisfied. We analyzed 38 patients who had undergone non-enhanced CT followed by CCTA on a PCD-CT. VNC reconstructions were performed at different settings and algorithms (conventional VNCConv; PureCalcium VNCPC). Virtual iodine "removal" was investigated by comparing histograms of heart volumes. Noise was assessed within the left ventricular cavity. Calcium was quantified on the true non-contrast (TNC) and all VNC series. The histograms were comparable for TNC and all VNC. Image noise between TNC and all VNC differed slightly but significantly. VNCConv CACS showed a significant underestimation regardless of the reconstruction setting, while VNCPC CACS were comparable to TNC. Correlations between TNC and VNC were excellent, with a higher predictive accuracy for VNCPC. In conclusion, the iodine contrast can be effectively subtracted from CCTA datasets. The remaining VNC series satisfy the requirements for CACS, yielding results with excellent correlation compared to TNC-based CACS and high predicting accuracy.

4Dimensional XStrain Echocardiography: Comprehensive Evaluation of Non-obstructive Hypertrophic Cardiomyopathy- A Case Report and Review of Literature

Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiomyopathy, which is occasionally challenging to differentiate from hypertensive heart disease and athletes heart on the basis of morphologic or functional abnormalities alone. Imaging studies provide solution for majority of clinical presentations. Generally, transthoracic echocardiography (TTE) is employed as a first line imaging tool and contrast enhanced echocardiography (CEE), contrast tuned imaging echocardiography (CTIE), cardiac magnetic resonance (CMR), cardiac computed tomography (CCT), cardiac nuclear imaging and speckle tracking echocardiography (STE) are encouraged for either suboptimal studies because of poor visualization of left ventricular (LV) cavity or for comprehensive delineation of the cardiac anatomy, its widespread left and right ventricular involvement, associations and complications. We are reporting a case of 48-year old male presenting to us with atypical chest pain and a history of suspicious solitary episode of syncope. His routine ECG was indicative of left ventricular hypertrophy with strain pattern, and his TTE was substandard and inadequate in the apical four chamber (4CH) and five chamber (5CH) views, hence CTIE was performed without the application of intravenous contrast agents, to produce a remarkable illustration of HCM.
 Keywords: Hypertrophic cardiomyopathy, contrast echocardiography, contrast tuned imaging, speckle tracking echocardiography, 4Dimensional XStrain, Non obstructive HCM

Cardiac ventricular false tendons: A meta-analysis.

Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.

Multimodality imaging in apical hypertrophic cardiomyopathy: clinical case

Apical hypertrophic cardiomyopathy is rare familial form of hypertrophic cardiomyopathy, with hypertrophy mainly affecting the apex of the left ventricle and characterized by a spade-like left ventricular cavity. Despite varying presentation, impaired capabilities of some standard instrumental methods and dissent on diagnostic criteria several diagnostic characteristics estimated by various noninvasive imaging modalities make it possible to establish a diagnosis with high accuracy. We hereby describe a case with electrocardiographic abnormalities and chest pain with suspected acute coronary syndrome. Acute coronary syndrome was excluded as well as performing invasive coronary angiography was avoided using advanced diagnostic tools including single photon emission computed tomography and apical hypertrophic cardiomyopathy was demonstrated by careful differential diagnosis.

The intraoperative visualisation technique during lead implantation into the cardiac conductive system: aspects of computed tomography: prospective study

INTRODUCTION: The lead implantation into the cardiac conduction system (CCS) is the most physiological method of pacing nowadays. «The method of intraoperative visualization and control of the lead position for permanent electrocardiostimulation during implantation of the lead in the CCS» has been developed for reduce the number of non-targeted implantations. This method based on the integration into the angiograph system 3D-reconstruction of the heart converted to computed tomography (CT) in the form of a mask against the background of fluoroscopy. CT is an important stage of the intraoperative visualization technique (IVT).OBJECTIVE: The aim of the study was to adapt the protocol of CT examination of the heart with contrast to construct a partially segmented 3D-reconstruction of the heart on an angiographic complex for subsequent use during of the lead implantation in the CCS within the framework of the author’s IVT.MATERIALS AND METHODS: As part of the development of the IVT, 21 CT studies of the heart were selected from own database. The step of the gradient of the density difference of the contrasted blood is about 10 HU, the range of the difference of densitometric parameters of the «left ventricle (LV) — right ventricle (RV)» from 0 HU to 200 HU. As well as selected 11 CT studies of the heart. The step of the gradient of the difference of densitometric indicators the contrasted blood in «the RV cavity — myocardium» is about 10 HU, the range is from 0 HU to 100 HU. All CT scans are alternately loaded into the angiograph, followed by the creation of a 3D model of the heart using basic software.RESULTS: It’s necessary to exceed the degree of contrast of the LV cavity over the RV cavity by at least 80 HU to perform partial segmentation on the left and right chambers of a 3D-model of the heart in an angiographic complex that does not have a specialized segmentation module. A sufficiently large part of the left ventricular cavity (LV) disappears with a smaller gradient when the right ventricular cavity (RV) is suppressed. The minimum gradient of «the ventricular cavity — myocardium» is at least 20 HU. The boundaries of the right ventricular edge of the interventricular septum (IVS) are not visualized with a smaller contrast gradient. It’s important for determining the insertion place of the lead into the IVS.CONCLUSION: It’s necessary to exceed the contrast of the LV cavities above the RV cavity by at least 80 HU, the RV cavity above the myocardium by at least 20 HU to perform partial segmentation on the left and right chambers of a 3D-model of the heart in an angiographic complex that does not have a specialized segmentation module

Echocardiographic Study of Ventricular Septal Defect in 1- to 12-Year-Old Children Visiting a Tertiary Care Center in Patna, India.

Background Symptoms of serious heart problems present at birthoften appear during the first few days, weeks, or months of a child's life. Shunt formation between the left and right ventricle is a crucial component of the pathophysiology of ventral septal defects. Objectives We aim to determine the most frequent types of ventricular septal defect (VSD) by echocardiography and whether there is any gender variation in the type of ventricular septal defect. Material and methods A total of 100 children who were clinically suspected of or diagnosed with VSD at the age of 1-12 years were enrolled in this study. The septum of the atrioventricular (AV) canal, the muscular septum, and the parietal band of the distal conal septum were evaluated by color Doppler. Ventricular septal defect (VSD) size and kind are similarly impacted by the 2D echo mode. The size and site of the VSD, associated congenital anomaly, and significant morphological changes in ventricular cavities, gender discrimination, and relation-specific types of ventricular septal defect were observed. Results A total of 100 VSD children presentedwith clinical symptoms of fast breathing, retraction of the chest, cough, cyanosis, fever, difficulty during feeding, cyanotic spell, chest pain, and edema at 65%, 62%, 54%, 52%, 54%, 29%, 9%, 11%, and 4%, respectively. Conclusion Early diagnosis is essential for effective medical care of diseases such as infective endocarditis (IE), which is present in some cases of VSD, and the avoidance of persistent pulmonary veno-occlusive disease (PVOD).

Alternative Method of Surgical Treatment of Post-Infarction Left Ventricular Free Wall Rupture. Case Report

Acute myocardial infarction (AMI) is one of the causes of death in developed countries, despite the latest medical technologies. AMI is usually accompanied by numerous fatal complications. One of these complications is left ventricular free wall rupture (LVFWR). Myocardial rupture after AMI can occur from 1 day to 3 weeks after the infarction. Most ruptures occur 3-5 days after a heart attack. Left ventricular free wall rupture requires only emergency surgical intervention, which in most cases consists in applying U-shaped sutures or wrapping sutures using Teflon patch.
 The aim. To demonstrate an example of alternative surgical tactics and intraoperative management of a patient with myocardial infarction complicated by rupture of the free wall of the heart with the transition to cardiogenic shock.
 Case report. We presented the clinical case of patient V., 72 years old, who was delivered by ambulance on January 10, 2023 to the intensive care department of the National Amosov Institute of Cardiovascular Surgery (Kyiv, Ukraine). Main diagnosis: ischemic heart disease, acute coronary syndrome with ST-elevation myocardial infarction, cardiogenic shock.
 Conclusion. The only effective method of treatment of rupture of the free wall of the heart is surgical intervention. Using a sandwich patch with resection of necrotic areas of the myocardium and U-shaped sutures with Teflon patch passed from the side of the left ventricular cavity through the myocardium in the peri-infarct zone and through a patch from a vascular prosthesis allows hermetically sew up the LVFWR.

Surgery for ventricular tachycardia originating from the left ventricular summit.

Ventricular tachycardia (VT) originating from the left ventricular summit region, the most superior region of the left ventricle surrounded by the major coronary arteries and veins, is frequently refractory to pharmacological therapies and endocardial and epicardial catheter ablation. Eleven patients with an age from 31 to 79 (median 56) years old, underwent map-guided surgery for left ventricular summit VT. All patients had undergone 1-5 unsuccessful sessions of catheter ablation for incessant VT, preoperatively. Five patients had suffered VT storm and 1 had a history of cardiopulmonary resuscitation. Four patients had implanted with a defibrillator. Epicardium to endocardium transmural cryothermia was applied at the VT origin determined by intraoperative epicardial mapping with electro-anatomical mapping system. Harmonic scalpel was used to remove the epicardial fat and cryothermia was applied directly to the myocardium, avoiding thermal or mechanical injuries to the coronary vessels. Additional endocardial cryothermia at the VT origin was performed by a cryoprobe introduced into the left ventricular cavity through an aortotomy. There was no surgical mortality or long-term mortality related to VT during a median follow-up period of 60 months (interquartile range: 34-82). Five-year freedom from preoperatively documented left ventricular summit VT and non-documented VT was 91% and 73%, respectively. All the patients with postoperative VT underwent successful catheter ablation. Other patients were free from VT during the follow-up period. Epicardial to endocardial transmural cryothermia at the VT origin guided by intraoperative electro-anatomical mapping with a close collaboration with electrophysiologists was crucial in successful surgery for left ventricular summit VT.

Assessment of papillary muscle free strain in hypertrophic cardiomyopathy and hypertension-induced left ventricular hypertrophy.

We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients. Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients. Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E' were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were - 14.52 ± 3.01 and -16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [-14.00% (-22 to -11%) and -15.5% (-24.02 to -10.16%) vs -23.00% (-24.99 to -19.01%) and -22.30% (-26.48 to -15.95%) (p = 0.016 and p = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of - 13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of -15.31 and -17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP. Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.

Two-dimensional speckle tracking imaging to assess the hazards of left ventricular function and ventricular wall motion disorders in children with pre-excitation syndrome and the efficacy of radiofrequency ablation treatment.

Our study aimed at analyzing the echocardiographic multi-indicator evaluation of the risk of Wolff-Parkinson-White syndrome (WPW) on the left ventricular function and ventricular wall motion disorders, as well as the effect of radiofrequency ablation treatment. The clinical data of 55 WPW patients treated with radiofrequency (RF) ablation at the Children's Hospital of Nanjing Medical University between January 2018 and December 2022 were retrospectively analyzed and included in the observation group, while other 50 healthy children were included in the control group during the same time. We analyzed the echocardiographic indices of the patients, assessed the effects of the disease on left ventricular myocardial function and ventricular wall motion disorders, and evaluated the effects of radiofrequency ablation treatment on the myocardium of the left ventricle. The echocardiographic parameters were analyzed to assess the effect of the disease on left ventricular myocardial function and ventricular wall dyskinesia. Of the 55 patients with pre-excited syndrome, 20 had type A bypass and 35 had type B bypass. Ten patients had pre-excited dilated cardiomyopathy with significant enlargement of the left ventricular cavity, reduced left ventricular systolic function, and a significant impairment of ventricular wall motion; the other 5 patients had basal segmental septal motion incoordination. Compared to the control group, patients with left ventricular end-diastolic diameter (LVEDD) (42.9±5.0 mm vs. 39.2±3.0 mm), peak strain dispersion (PSD) (38.8±15.3 ms vs. 21.7±2.2 ms), maximum peak time difference (MPTD) (200.2±92.8 ms vs. 89.5±9.8 ms) and interventricular mechanical delay (IVMD) (36.2±13.7 ms vs. 21.2±2.1 ms) before RF ablation were increased. Left ventricular ejection fraction (LVEF) (57.1±9.1% vs. 65.9±2.6%), E/A (1.1±0.2 vs. 1.8±0.2) and global longitudinal strain (GLS) (-18.7±2.2% vs. -22.4±0.5%) decreased, with statistically significant differences (p<0.05). All 55 patients had a successful procedure, and all postoperative echocardiographic parameters were found to be improved, compared to the preoperative period. The results of the postoperative review after 3 months showed differences in E/A, PSD, MPTD, and IVMD compared to the healthy group, suggesting that left ventricular diastolic function and synchrony had not fully returned to normal. Echocardiography can better evaluate myocardial motion and function in patients with Wolff-Parkinson-White syndrome and monitor the effect and progress of disease treatment, and has high clinical application value.

Ekhokardiohrafichni predyktory vynyknennia riznykh uskladnen systemy krovoobihu u khvorykh iz hostrym koronarnym syndromom (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. A big number of publications are reporting results obtained while using echocardiography (EchoCG) in heart diseases. However, so far, applicability of EchoCG data to predict possible complications in cardiovascular system have not been studied sufficiently. The aim of the study. Using available literature and own research results to analyze EchoCG predictors of the development of various complications of the blood circulatory system during acute coronary syndrome. Materials and methods. Literature review covered 41 analyzed articles, results of which were compared with our own observations. Results. Two years after the myocardial infarction there exist several variants of further disease development: favorable, with the preserved left ventricle dysfunction; conditionally preserved and moderately preserved, with pronounced dilatation and compensatory left ventricle hypertrophy; and unfavorable, with reduced left ventricle systolic function accompanied by the increased end systolic and end diastolic volumes. Repeated myocardial infarction is more often supplemented with the secondary myocardial necrosis in the perifocal zone and dilatation of the left ventricular cavities. Our observations revealed that violation of myocardial contractility is manifested in those cases, when the myocardial damage exceeds 20.0 % of the thickness of the left ventricular wall; in those cases, when the damage covers from 20.0 to 50.0 % – a Q wave is registered on the electrocardiography. Prognostic predictors and criteria for the development of unfavorable cardiovascular events after being subjected to ST elevation of myocardial infarction include: increased angina attacks, progression of congestive heart failure, age over 60 years, increased heart rate more than 90 beats/min, ventricular extrasystole 3-5 grades according to B. Laun, elevation of the ST segment more is equal 1 mm, left ventricle hypertrophy, alteration of two or more coronary arteries. Conclusions. Unfavorable prognostic predictors according to EchoCG data are as follows: increased end diastolic and end systolic volumes, decreased left ventricular ejection fraction is less than 40.0 % on the background of early or late remodeling, concentric type of remodeling. Eccentric left ventricular ejection fraction, being initially compensatory in nature, due to its increased severity and cardiomegaly accompanied by a decrease in left ventricular ejection fraction is less than 40.0 % – decompensated. Predictors of the right cardiac cusp are: ventricular extrasystoly of 3-5 gradations, ventricular tachicardia of the “pirouette” type, prolongation of Q-T interval, decrease in left ventricular ejection fraction is less than 40.0 %, increased anginal attacks and progression of congestive heart failure. Keywords: echocardiographic predictors, acute coronary syndrome, myocardial infarction, ventricular extrasystole.

Is there a relationship between Haller Index and cardiopulmonary function in children with pectus excavatum?

This study aims to systematically examine the cardiopulmonary functions in children with pectus excavatum and to compare the obtained findings with the Haller Index. Between September 2017 and June 2018, medical records of a total of 31 patients (27 males, 4 females; mean age: 14.8±2.0 years; range, 9 to 18 years) with pectus excavatum were retrospectively analyzed. The patients were divided into Group 1 (<2.5), Group 2 (2.5 to 3.19), and Group 3 (>3.2) according to the Haller Index. All groups were systematically evaluated based on pulmonary function tests and echocardiography. Forced vital capacity, forced expiratory volume in 1 second, and the forced expiratory volume in 1 second/ forced vital capacity ratio were calculated. Left ventricular enddiastolic diameter, ejection fraction, mitral valve prolapses, and right ventricular cavity in the apical four-chamber position were evaluated with echocardiography. Of the patients, 19.4% were in Group 1, 38.7% in Group 2, and 41.9% in Group 3. The mean Haller Index value was 3.09±0.64. According to pulmonary function test results, 16.1% of the patients had restrictive disease and 6.5% had obstructive disease. There was a negative correlation between the index and forced expiratory volume in 1 second and forced vital capacity, and there was a statistically significant decrease in these values, as the Haller Index increased (p<0.017). There was a significant difference in the ejection fraction among the groups (p<0.001) and, as the Haller Index increased, ejection fraction statistically significantly decreased. Our study results show a negative correlation between the severity of pectus excavatum and pulmonary dysfunction and, as the severity increases, left ventricular function may be affected by the deformity. As a result, there seems to be a significant relationship between the severity of the deformity and cardiopulmonary functions.

Endomyocardial fibrosis in a 12-year-old boy

Abstract Endomyocardial fibrosis (EMF) is characterized by the abnormal scarring of the endocardium with deposition of fibrous tissues in the apices and inflow tracts of the right ventricle, left ventricle, or both, leading to symptoms such as heart failure, arrhythmias, and intracardiac thrombosis. EMF is a rare cause of cardiac morbidity and mortality in children of the tropics including Nigeria, hence the presentation of this case report. A 12-year-old male presented to Children emergency ward with abdominal swelling from infancy, which worsened 3 months before presentation, leg swelling and weight loss of 3 months, cough of 1 month, and fast breathing of 1 week. Physical examination revealed dyspnea, pedal and leg edema, absent breath sounds in the right middle and lower lung zone, tachycardia, irregular pulse, elevated jugular venous pressure, and a grossly distended abdomen. Echocardiography demonstrated dilated atria, thickened AV valves, small, thickened ventricular cavities, intra-atrial thrombus, fibrous tissue in the apices and inlets of left and right ventricles, and pericardial effusion. Electrocardiography revealed first-degree AV block, left anterior fascicular block, and left atrial enlargement. Chest radiograph revealed right lobar pneumonia, pleural effusion, and cardiomegaly. The abdominopelvic scan revealed congestive hepatomegaly and ascites. He received diuretics, beta-blockers, aspirin, and antibiotics. Repeated abdominal paracentesis, thoracocentesis, and pericardiocentesis drained 14.2 L, 1.5 L, and 2.1 L of serosanguineous fluid, respectively. EMF is an enigmatic disease which requires further research to unravel its underlying mechanisms and develop more targeted therapeutic strategies.

Myocardial edema at CMR imaging end evolution of ventricular function following COVID-19 myocarditis - insights from the CARDIOCOV study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022). Background Myocarditis following SARS-COV-2 infection has recently become a subject of concern, being detected in a significant number of post-COVID-19 patients who undergo cardiac magnetic resonance(CMR) examination. While the role of CMR in detecting presence of viral myocarditis has been well established, the CMR features associated with significant alteration of ventricular function in post-COVID patients are not clearly identified yet. Purpose The aim of the study was to investigate the role of myocardial edema (ME) at CMR for predicting the evolution of ventricular function in patients with COVID myocarditis. Methods In total, 55 patients with CMR signs of viral myocarditis following COVID-19 infection (52.72% males, mean age 36.85+/-16.29) were enrolled in the study. The delayed gadolinium enhancement phase-sensitive inversion recovery sequences were used for characterization of the myocardial tissue, and inversion recovery images showing high signal intensity were considered suggestive of edematous changes. Patients were divided into 2 study groups, according to the presence of myocardial edema at the moment of CMR evaluation: group 1 (n=18, 32.72%) - patients without ME, and group 2 (n=37, 67.27%)-patients with ME identified by CMR. In all patients, end-distolic and end-systolic volume indexes (EDVI and ESVI), ejection fraction (EF) and stroke volume (SV) were calculated. Results Compared to patients without ME, those with ME present at CMR were older n (42.9+/-14.8 vs. 36.7+/-16.6, p = 0.145) and more frequently males(59.4% vs. 38.8%). At the same time, EF was significantly lower in patients with ME(50.9+/-14.5% in group 2 vs. 58.4+/-10.2% in group 1, p = 0.03). Patients from group 2 also exhibited a more pronounced dilatation of ventricular cavities, as reflected by a significant increase of ventricular volumes and especially of the ESVI(109.8+/-125.9 versus 80.1+/-14.2, p = 0.5 for EDVI, and 65.2+/-109.1 vs. 30.0+/-11.4, p = 0.02 for ESVI). Compared to the group without ME, those with ME presented a significantly lower stroke volume index: 44.2+/-17.3 in group 1 vs. 47.7+/-7.5, p = 0.03 in group 2. Conclusions In patients with COVID-19 myocarditis, presence of ME at CMR imaging is associated with a worse evolution of the left ventricular function, as reflected by increased ventricular dilatation and decreased cardiac output in the post-COVID period.