Ventricular Cavity Research Articles

The Value of Diffuse Splenic and Hepatic 18F-FDG Uptake on PET/CT in Diagnosing Patients with Anemia.

Objective Anemia is a disease with a negative impact on the progression and prognosis of tumor diseases and usually diagnosed by blood tests. Imaging examination has been used as an alternative method to diagnose anemia in addition to blood tests for patients who cannot tolerate blood draw (such as those with severe coagulopathy). The purpose of this study was to investigate the role of diffuse splenic and hepatic 18F-FDG uptake on PET/CT in anemia, by analyzing the correlation between the hemoglobin level and diffuse splenic and hepatic as well as marrow 18F-FDG uptakes in patients who underwent PET/CT. Materials and Methods Forty four patients who underwent a peripheral blood examination within 2 days of a 18F-FDG-PET/CT in our hospital from March 2020 to March 2021 were included. The standardized uptake value (SUV) of the spleen, liver, and marrow were measured, including the maximum value (SUVmax) and the mean value (SUVmean), and the CT value (CTV) of the left ventricular (LV) cavity was measured, including the maximum value (CTVmax) and the mean value (CTVmean). The relation between these measurements and the blood hemoglobin level were analyzed. Results Our analysis revealed that the hemoglobin level was negatively correlated with the SUVmax of the spleen (P ≤ 0.01, R = −0.385), SUVmean of the spleen (P ≤ 0.01, R = −0.395), SUVmax of the liver (P ≤ 0.05, R = −0.365), and SUVmean of the liver (P ≤ 0.05, R = −0.315). The hemoglobin level was positively correlated with CTVmax of the LV cavity (P ≤ 0.05, R = 0.33) and CTVmean of the LV cavity (P ≤ 0.05, R = 0.382), while no statistically significant correlation between the hemoglobin level and the SUV of marrow was observed (P > 0.05). Conclusion Our study revealed a negative correlation between the hemoglobin level and spleen SUV as well as liver SUV, and a positive correlation between the hemoglobin level and CTV of the LV cavity. These findings may provide potential indictors for the imaging diagnosis of anemia, which has important clinical significance in certain clinical scenarios including the evaluation of anemia status in patients who cannot tolerate blood draws and retrospective clinical studies based on patient imaging data.

Deep Learning Approach for Cardiac MRI Images

Deep Learning (DL) is the most widely used image-analysis process, especially in medical image processing. Though DL has entered image processing to solve Machine Learning (ML) problems, identifying the most suitable model based on evaluation of the epochs is still an open question for scholars in the field. There are so many types of function approximators like Decision Tree, Gaussian Processes and Deep Learning, used in multi-layered Neural Networks (NNs), which should be evaluated to determine their effectiveness. Therefore, this study aimed to assess an approach based on DL techniques for modern medical imaging methods according to Magnetic Resonance Imaging (MRI) segmentation. To do so, an experiment with a random sampling approach was conducted. One hundred patient cases were used in this study for training, validation, and testing. The method used in this study was based on full automatic processing of segmentation and disease classification based on MRI images. U-Net structure was used for the segmentation process, with the use of cardiac Right Ventricular Cavity (RVC), Left Ventricular Cavity (LVC), Left Ventricular Myocardium (LVM), and information extracted from the segmentation step. With train and using random forest classifier, and Multilayer Perceptron (MLP), the task of predicting the pathologic target class was conducted. Segmentation extracted information was in the form of comprehensive features handcrafted to reflect demonstrative clinical strategies. Our study suggests 92% test accuracy for cardiac MRI image segmentation and classification. As for the MLP ensemble, and for the random forest, test accuracy was equal to 91% and 90%, respectively. This study has implications for scholars in the field of medical image processing.

CAUDAL MIGRATION AND TRANS-ANAL EXTRUSION OF VENTRICULOPERITONEAL SHUNT IN A CHILD : A CASE REPORT

Ventriculo-peritoneal shunts are one of the commonest surgical procedures performed in neurosurgery for diversion of cerebrospinal uid for hydrocephalus. Excess amount of cerebrospinal uid is drained unidirectionally from obstructed ventricular cavities into the peritoneum in the management of hydrocephalus. VP shunt sometimes causes complications. Complications can be mechanical ( obstruction, disconnection and migration ) or non mechanical (infection and distal compartment related like pseudocyst 1,2 formation , ascites and pleural effusion). Migration can be dened as translocation of the part/ whole of the shunt system (proximal/ distal catheter / reservoir/ valves ) from the compartment where it was intended to be to a new compartment which may be associated with/ without shunt dysfunction. In general, a caudal migration is more common 3 than a cranial migration. Bowel perforation caused by the ventriculo-peritoneal shunt is a rare occurrence with an estimated incidence rate of 0.1% to 1.0% among all cases of VP shunt displacement. Perforation of the bowel wall by VP shunt is a surgical emergency. Awareness and early recognition of this complication are essential because of the 4 high mortality rate in such patients. In this present case report, a 5 year olds male child presented with anal protrusion of VP shunt with fever and signs of shunt malfunction. Early diagnosis and treatment of this complication is essential to minimize or prevent infectious and neurological consequences

A rare case report of severe cardiomyopathy associated with myotonic dystrophy type 2

BackgroundMyotonic dystrophies (DM) are multi-systemic diseases characterized by muscle weakness and myotonia. Despite a growing appreciation for the cardiovascular manifestations in myotonic dystrophy type 1 (DM1), cardiac involvement in myotonic dystrophy type 2 (DM2) has been less well characterized. In patients with DM2, cardiomyopathy has rarely been described. Case summaryThis case report describes a rare case of DM2 associated cardiomyopathy. A 56-year-old male with DM2 who presented with palpitations and fatigue. Cardiac magnetic resonance (CMR) imaging confirmed a severely enlarged left ventricular cavity with a left ventricular ejection fraction of 28% consistent with severely reduced global systolic function. The lateral wall epicardium exhibited late gadolinium enhancement in a pattern seen in myotonic dystrophy-related cardiomyopathy.DiscussionThis case highlights the potential for significant cardiovascular involvement in DM2, as well as the importance of screening, including CMR imaging, and therapy in the myotonic dystrophy patient population.

Making Semi-Automatic Segmentation Method to be Automatic Using Deep Learning for Biventricular Segmentation

Ventricular Segmentation or Delineation of Cardiac Magnetic Resonance Imaging (CMRI) is significant in obtaining the cardiac contractile function, which in turn is taken as input for diagnosing Cardio Vascular Diseases (CVD). Many automatic and semi-automatic methods were evolved to meet the constraints of diagnosing CVDs. Among these, semi-automatic methods require user intervention for delineation of ventricles, which consumes time and leads to intra and inter-observability, as with manual delineation. Thus, the automatic method is suggested by most of the researchers to address the above-stated problem. We proposed Saliency-based Active contour U-Net (SACU-Net) for automatic bi-ventricular segmentation which is found to surpass the existing highest developed methods regarding closeness to the gold standard. Three schemes are used by our proposed algorithm, namely 1. Saliency Detection Scheme for Region of Interest (ROI) Localization to concentrate only on Object of Interest, 2. Drop-out embedded U-net for Initial Contour evolution that performs initial segmentation and 3. Local-Global-based Regional active Contour (LGRAC) to fine-tune and avoid leaking, merging of ventricles during Delineation. We used three datasets namely Automatic Cardiac Diagnosing Challenge (ACDC) of MICCAI 2017, Right Ventricular Segmentation Challenge (RVSC) of MICCAI 2012, and Sunny Brook (SB) of MICCAI 2009 dataset to test the adaptability nature of our algorithm over different scanner resolutions and protocols. 100 and 50 CMRI Images of ACDC were used for training and testing respectively which obtained average Dice Coefficient (DC) metric of 0.963, 0.934, and 0.948 for Left Ventricular Cavity (LVC), Left Ventricular Myocardium (LVM), and Right Ventricular Cavity (RVC) respectively. 32 and 16 CMRI Images of RVSC are used for preparing and experimenting respectively, which obtained an average DC metric of 0.95 for RVC.30 and 15 CMRI Images of SB are used for preparing and experimenting respectively, which obtained average DC metric of 0.96 and 0.97 for LVC and LVM, respectively. Hausdorff Distance (HD) Metrics are also calculated to learn the distance of proposed delineated ventricles to reach the gold standard. The above resultant metrics show the robustness of our proposed SACU-Net in the segmentation of ventricles of CMRI than previous methods.

Contribution of Longitudinal and Circumferential Shortening to Stroke Volume and Ejection Fraction in Severe Aortic Stenosis

Background: Left ventricular (LV) stroke volume (SV) is ejected by a combination of longitudinal shortening (LS), circumferential shortening (CS) and ventricular twist. Longitudinal shortening is caused by the motion of the mitral annulus towards the apex, causing wall thickening (circumferential and radial shortening), and left ventricular cavity and SV reduction. The role of LS in aortic stenosis (AS) is not defined. Objective: The aim of this study was to analyze the LS and CS contribution to SV and left ventricular ejection fraction (LVEF) in severe AS. Methods: The study included 152 patients (70±12 years, 64 women) with severe AS (valve area <1 cm2 ) studied by cardiac Doppler echocardiography. The LS contribution to SV was evaluated by considering the base of the heart as a cylinder, with volume=base x height; the base was assumed as a circle with radius equal to (systolic septal thickness+systolic posterior wall thickness+end-systolic diameter)/2; and height, as an average of the mitral lateral, septal, anterior and inferior annulus systolic excursion. The CS contribution to SV was estimated as: SV - LS contribution to SV. Both contributions were expressed in absolute form and as SV percentages (% SV-LS and % SV-CS). Results: Longitudinal shortening contributed with approximately 2 thirds of SV (68±18 %) and CS with the rest. SV-LS correlated inversely with SV (r= - 0.45 p <0.001) and SV-CS had direct correlation (r=0.45 p <0.001). The % SV-LS contribution was greater in patients with LVEF < 50%. Percent SV-LS correlated inversely with relative wall thickness (RWT) (r=0.32, p < 0.01). Conclusion: The LS contribution to SV is greater than that of CS, and correlates inversely with SV. Percent SV-LS is higher in patients with LVEF <50%. The aforementioned findings could have implications when considering cut-off points for longitudinal function indices (strain) without considering LVEF and/or ventricular geometry

Rare Case of an Adult With Double-Chambered Left Ventricle.

The rare case of an adult with a double-chambered left ventricle was revealed using multimodality imaging using echocardiography and cardiac magnetic resonance imaging in a 38-year-old asymptomatic male patient. The congenital malformation was dominated by a second, coarsely trabeculated muscular shelf dividing the left ventricle into 2 chambers without signs for left ventricular inflow or outflow tract obstruction. The partition wall did not show any signs for intramyocardial fibrosis in late gadolinium enhancement cardiovascular magnetic resonance imaging. Flow measurements excluded a relevant intracardial shunt across the additive perimembranous ventricular septal defect. There were no signs for global right and left ventricular dysfunction with left and right ventricular volumes and ejection fraction within normal limits. A conservative approach was recommended. In summary, we are able to present the case of an adult with a double-chambered left ventricle with a second muscular "septum" partially dividing the left ventricular cavity without causing a relevant impact on cardiac function or clinical signs for heart failure.

Left ventricular non-compaction associated with a MYH7 splicing variant (c.818+1G>A)

Left Ventricular Noncompaction (LVNC) is a cardiac disease characterized by a trabecular meshwork and deep intertrabecular myocardial recesses that communicate with the left ventricular cavity. MYH7 splicing mutations are very rare, and seem to be restricted to patients with myopathy of LVNC. We characterized at the Cardiac Magnetic Resonance (CRM) and genetic levels in one individual (index case) from a family with LVNC. The patient was heterozygous carrier of a splicing MYH7 intron 8 variant (c.818+1G>A). One of his sons was also mutation carrier but clinically asymptomatic. However, the CRM showed the presence of LVNC. We concluded that the rare MYH7 intron 8 splicing mutation was associated with typical LVNC lesions in the CRM, albeit mutation carriers remain clinically asymptomatic. Keywords: left ventricular non-compaction; MYH7 gene; RNA decay; cardiac magnetic resonance.

Development of a dedicated 3D printed myocardial perfusion phantom: proof-of-concept in dynamic SPECT

We aim to facilitate phantom-based (ground truth) evaluation of dynamic, quantitative myocardial perfusion imaging (MPI) applications. Current MPI phantoms are static representations or lack clinical hard- and software evaluation capabilities. This proof-of-concept study demonstrates the design, realisation and testing of a dedicated cardiac flow phantom. The 3D printed phantom mimics flow through a left ventricular cavity (LVC) and three myocardial segments. In the accompanying fluid circuit, tap water is pumped through the LVC and thereafter partially directed to the segments using adjustable resistances. Regulation hereof mimics perfusion deficit, whereby flow sensors serve as reference standard. Seven phantom measurements were performed while varying injected activity of 99mTc-tetrofosmin (330–550 MBq), cardiac output (1.5–3.0 L/min) and myocardial segmental flows (50–150 mL/min). Image data from dynamic single photon emission computed tomography was analysed with clinical software. Derived time activity curves were reproducible, showing logical trends regarding selected input variables. A promising correlation was found between software computed myocardial flows and its reference (rho= − 0.98; p = 0.003). This proof-of-concept paper demonstrates we have successfully measured first-pass LV flow and myocardial perfusion in SPECT-MPI using a novel, dedicated, myocardial perfusion phantom.Graphical abstractThis proof-of-concept study focuses on the development of a novel, dedicated myocardial perfusion phantom, ultimately aiming to contribute to the evaluation of quantitative myocardial perfusion imaging applications.

Total Migration of the Lumbo-peritoneal valve from D4 to V4: Case Report

The valve devices are designed for the treatment of hydrocephalus, Ventriculoperitoneal shunt (VPS) and lumbopperitoneal shunt (LPS), but they have two complications: infectious and mechanical. Among the latter, we find the dysconnection and migrations of parts of the valves either in the intracranial ventricular cavities or in the natural cavities of the patient's body (heart, colon, bladder, lung, vena cava, etc.) even externalization. through natural orifices.

Molecular Mechanisms and Risk Factors for the Pathogenesis of Hydrocephalus.

Hydrocephalus is a neurological condition due to the aberrant circulation and/or obstruction of cerebrospinal fluid (CSF) flow with consequent enlargement of cerebral ventricular cavities. However, it is noticed that a lot of patients may still go through symptomatic progression despite standard shunting procedures, suggesting that hydrocephalus is far more complicated than a simple CSF circulative/obstructive disorder. Growing evidence indicates that genetic factors play a fundamental role in the pathogenesis of some hydrocephalus. Although the genetic research of hydrocephalus in humans is limited, many genetic loci of hydrocephalus have been defined in animal models. In general, the molecular abnormalities involved in the pathogenesis of hydrocephalus include brain development and ependymal cell dysfunction, apoptosis, inflammation, free radical generation, blood flow, and cerebral metabolism. Moreover, recent studies have indicated that the molecular abnormalities relevant to aberrant cerebral glymphatic drainage turn into an attractive subject in the CSF circulation disorder. Furthermore, the prevalent risk factors could facilitate the development of hydrocephalus. In this review, we elicited some possible fundamental molecular mechanisms and facilitating risk factors involved in the pathogenesis of hydrocephalus, and aimed to widen the diagnosis and therapeutic strategies for hydrocephalus management. Such knowledge could be used to improve patient care in different ways, such as early precise diagnosis and effective therapeutic regimens.

Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes.

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Performance Evaluation of a Preclinical SPECT Scanner with a Collimator Designed for Medium-Sized Animals.

Background Equipped with two stationary detectors, a large bore collimator for medium-sized animals has been recently introduced for dedicated preclinical single-photon emission computed tomography (SPECT) imaging. We aimed to evaluate the basic performance of the system using phantoms and healthy rabbits. Methods A general-purpose medium-sized animal (GP-MSA) collimator with 135 mm bore diameter and thirty-three holes of 2.5 mm diameter was installed on an ultrahigh-resolution scanner equipped with two large stationary detectors (U-SPECT5-E/CT). The sensitivity and uniformity were investigated using a point source and a cylinder phantom containing 99mTc-pertechnetate, respectively. Uniformity (in %) was derived using volumes of interest (VOIs) on images of the cylinder phantom and calculated as [(maximum count − minimum count)/(maximum count + minimum count) × 100], with lower values of % indicating superior performance. The spatial resolution and contrast-to-noise ratios (CNRs) were evaluated with images of a hot-rod Derenzo phantom using different activity concentrations. Feasibility of in vivo SPECT imaging was finally confirmed by rabbit imaging with the most commonly used clinical myocardial perfusion SPECT agent [99mTc]Tc-sestamibi (dynamic acquisition with a scan time of 5 min). Results In the performance evaluation, a sensitivity of 790 cps/MBq, a spatial resolution with the hot-rod phantom of 2.5 mm, and a uniformity of 39.2% were achieved. The CNRs of the rod size 2.5 mm were 1.37, 1.24, 1.20, and 0.85 for activity concentration of 29.2, 1.0, 0.5, and 0.1 MBq/mL, respectively. Dynamic SPECT imaging in rabbits allowed to visualize most of the thorax and to generate time-activity curves of the left myocardial wall and ventricular cavity. Conclusion Preclinical U-SPECT5-E/CT equipped with a large bore collimator demonstrated adequate sensitivity and resolution for in vivo rabbit imaging. Along with its unique features of SPECT molecular functional imaging is a superior collimator technology that is applicable to medium-sized animal models and thus may promote translational research for diagnostic purposes and development of novel therapeutics.

КЛИНИКО-ГЕМОДИНАМИЧЕСКАЯ ОЦЕНКА ПАЦИЕНТОВ С НЕРЕВМАТИЧЕСКОЙ НЕДОСТАТОЧНОСТЬЮ ТРЕХСТВОРЧАТОГО КЛАПАНА СЕРДЦА (ФУНКЦИОНАЛЬНОЙ) ПРИ ХРОНИЧЕСКИХ ФОРМАХ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА ИЛИ ДИЛАТАЦИОННОЙ КАРДИОМИОПАТИИ

Objectives: to study and compare the clinical and echocardiographic characteristics of patients with functional (secondary) tricuspid insufficiency, depending on its etiology and depending on the surgical methods used in surgical practice for its correction. Materials and methods: clinical and hemodynamic assessment of a population of patients with non-rheumatic tricuspid valve insufficiency (functional) in chronic forms of coronary heart disease (CHD) or dilated cardiomyopathy (DCMP) was performed. The study included 792 patients who underwent correction of non-rheumatic tricuspid valve insufficiency (functional) during a period 2011–2020: 642 participants with coronary artery disease, 150 participants with DCMP. Clinical and echocardiographic parameters were assessed. Results: In the analyzed patient population, in-hospital mortality after surgery in patients with CAD was significantly higher than in patients with DCMP, which can be explained by a number of factors, including the more severe nature of the pathology in patients with CAD (in the study, patients with multiple coronary arteries lesions and a high functional class of angina prevailed in the group of coronary artery disease), and a larger scale of surgical intervention. In patients with DCMP, a more significant dilatation of the right ventricular cavity and a significantly higher increase of right ventricle volumes were noted. At the same time, despite more significant remodeling of the left (LV) and right ventricles (RV), the level of systolic and mean pulmonary artery pressure did not differ significantly between patients with CAD and DCMP. There was no significant difference in the levels of dilatation and volume of the right atrium between patients with CHD and DCMP. Patients with DCMP showed more severe dilatation of the tricuspid valve annulus and the area of its orifice. However, when assessing the magnitude of the degree of severity of the functional tricuspid valve insufficiency, no significant differences were noted in almost all parameters, depending on the etiology. Despite a comparable volume of regurgitation and the degree of tricuspid valve insufficiency, patients with DCMP had a significantly more severe changed geometry of the tricuspid valve annulus. Ring plasty techniques were used in patients with more pronounced LV remodeling and severe LV systolic dysfunction. This, most likely, caused a more significant overload of the pulmonary circulation, causing a higher level of pulmonary hypertension and volume overload of the right heart. In patients with CHD, suture repair methods were more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve were used more often. At the same time, regardless of the etiology, ring annuloplasty techniques were used with more severe functional insufficiency of the TV in patients with a significantly more significant decrease in right ventricular contractility. Conclusion: in the study population, hospital mortality was higher in the CHD group than in the DCMP group. In DCMP, a more pronounced dilatation of the tricuspid valve annulus and the area of its opening were observed, however, the degree of severity of the functional insufficiency of the tricuspid valve in all respects does not depend on the etiology. In patients with DCMP, there is a significantly more pronounced violation of the geometry of the tricuspid valve annulus. In patients with coronary heart disease, suture repair methods are more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve are used. Both in CHD and DCMP, ring plasty of tricuspid valve were used in cases of more severe functional insufficiency in patients with a significantly more decreased contractility of the left and right ventricles.

Ebstein Anomaly of the Tricuspid Valve with Intact Inter-Atrial Septum and Cor Triatriatum Dexter in an Asymptomatic Adult

Ebstein anomaly of the tricuspid valve is characterized by apical displacement of septal and posterior leaflets of the tricuspid valve leading to the atrialization of right ventricular cavity and severe low-pressure tricuspid regurgitation. Cor triatriatum dexter is a rare congenital cardiac anomaly in which a membranous structure divides the right atrium into two chambers. This combination is rare and very few cases have been described in the literature. We herein report an asymptomatic young female who was incidentally detected to have these anomalies with intact atrial septum. Echocardiographic examination showed tri-chambered right atrium consisting of atrialized right ventricle, anterior right atrial chamber, and the posterior right atrial sinus portion.

Midterm Prognosis of Sexagenary Patients after Transcatheter Device Closure of Atrial Septal Defects: a Single-Chinese Center Experience.

IntroductionThe objective of this study is to evaluate the efficacy and midterm prognosis of transcatheter device closure of atrial septal defects (ASDs) in sexagenary patients in China.MethodsForty-six sexagenary patients who underwent transcatheter device closure of ASDs in our hospital were included in this study. The patients’ preoperative and postoperative clinical symptoms, echocardiographic results, and quality of life were investigated and analyzed.ResultsOf the 46 sexagenary patients who participated in the study, 40 completed the study. After ASD closure, the clinical symptoms of the patients significantly improved, and the number of patients with dyspnea and palpitations significantly decreased after the operation. According to the echocardiographic results, few patients had a tiny residual shunt after closure, but the shunt disappeared completely at the three-month follow-up. The size of the right ventricular cavity was significantly smaller postoperatively compared with preoperatively. Regarding the patients’ quality of life, their feedback in all dimensions of the 36-Item Short-Form Health Survey (or SF-36) was significantly improved at the three-month follow-up, and it remained improved at the one-year follow-up.ConclusionThe clinical outcomes and subjective quality of life of sexagenary patients with ASDs improved significantly after transcatheter device closure of ASDs. Therefore, we believe that for sexagenary patients with ASDs, transcatheter device closure is a favorable treatment.

How to build a successful hypertrophic cardiomyopathy team and ensure training the next generation of myectomy surgeons.

Transaortic extended septal myectomy is the most reliable method for septal reduction for symptomatic patients with obstructive hypertrophic cardiomyopathy. In addition, surgical management of nonobstructive hypertrophic cardiomyopathy is possible for selected patients with diastolic heart failure and small left ventricular end-diastolic cavity dimensions. These procedures, however, are performed infrequently in many centers, and trainees may not be exposed to the preoperative evaluation and intraoperative management of patients with hypertrophic cardiomyopathy. In this paper, we review what we believe are the central features for creating a successful program for septal myectomy and detail our strategies to optimize instruction in these techniques for residents and fellows.

Noncompaction of left ventricle - a rare cardiomyopathy

Non-compaction of left ventricular (NCLV) is a rare cardiomyopathy of unknown origin characterized by prominent ventricular trabeculations and deep intertrabecular sinusoids, in communication with the left ventricular cavity. The NCLV results due to failure of compaction during foetal development. In this study, five children were diagnosed with NCLV out of 135 cases of cardiomyopathy and the youngest case was diagnosed at 27th day of life. Congestive cardiac failure presenting as tachycardia and tachypnea were common clinical manifestations. Early detection of NCLV helps patients to get timely treatment. NCLV should be considered as one of the differential diagnosis amongst cases of cardiomyopathy.

Noncompaction of the left ventricular myocardium as a cause of stroke in young people: a report of two cases / Não compactação do miocárdio ventricular esquerdo como causa de AVC em jovens: um relatório de dois casos

Left ventricular noncompaction is a rare cardiomyopathy, of unknown etiology, characterized by a compacted epicardium, and an endocardium with prominent LV trabeculae and deep intertrabecular recesses that communicates with the ventricular cavity. It has been linked to thromboembolic complications in 5% to 38% of cases, even in young patients, due to possible thrombogenesis in the intertrabecular recesses and association with cardiovascular or coagulation abnormalities, which increase the risk of systemic embolism. Noncompaction of the Left Ventricular Myocardium is considered an underdiagnosed condition. Stroke is one of its main complications, and prophylactic anticoagulation is recommended in patients with LV EF ≤ 40%, history of embolism or transient ischemia, atrial fibrillation and intracardiac thrombi identified in imaging exams.

105 An intriguing case of pericardial effusion after acute coronary syndrome

Abstract Aims Left ventricular free wall rupture is one of the mechanical complications of myocardial infarction with an incidence of 2–4%. Sometimes the myocardial rupture hasn’t an immediate fatal evolution, nor is easy to be diagnosed because it is contained by the pericardium and thrombus formation, leading to pseudoaneurysm of the left ventricle. Pseudoaneurysms need a prompt surgical correction for their high risk of rupture both in the acute phase and later. Methods and results A 57 years old, smoker, woman with no previous cardiological history was admitted to our cardiological department for acute coronary syndrome with persistent ST segment elevation involving the postero-lateral wall (door to balloon time about 10 h, Killip class I and peak hs-TnI value was 27.67 ng/ml n.v. ˂0.02 ng/ml). The echocardiography showed mild left ventricular disfunction (LV EF 45%), postero lateral akinesia and moderate mitral regurgitation; ubiquitous pericardial effusion (1 cm) was present, particularly along the anterior left ventricular wall, with irregular echo-dense aspect. She underwent urgent coronarography that showed a critical stenosis of the distal third of the left circumflex and a thrombotic occlusion of the first marginal branch. The distal circumflex was treated with angioplasty and stent implantation but we couldn’t obtain the reperfusion of the marginal branch. Post procedural echocardiogram was unchanged and no free wall rupture was detected. 7 days after the admission, the patient showed persistent elevation of white blood count and CRP and developed fever, promptly empirically treated with a cephalosporin (blood cultures collected before were negative). After two new episode of fever with persisting biochemical flogistic parameters, a rheumatologic cause of the pericardial effusion was considered in the presence of positive antinuclear antibodies suggesting the diagnosis of Systemic Lupus Erythematosus. Steroidal therapy was prescribed which caused clinical improvement without complete resolution of the pericardial effusion. On day 20 of hospital stay a new echocardiographic evaluation showed a discontinuation of the postero lateral myocardial wall (Figure 1), about 1 cm in width, widely communicating with the left ventricular cavity and suggestive for a left postero-lateral ventricular pseudoaneurysm. The patient underwent surgical intervention and it was possible to expose a big clot occluding the pseudoaneurysmatic cavity communicating with the left ventricular chamber through an inlet about 1 cm in diameter, that was repaired with a bovine pericardial patch (Bard Sauvage technique). After surgery the patient was supported with an IABP and inotropes and was discharged to a rehabilitation structure on day 29 of hospital stay. Four months after the hospital discharge the patient died for a recently diagnosed pancreatic cancer. Conclusions Pseudoaneurisms are life-threatening complications of myocardial infarction that sometimes are hardly diagnosed. When correctly recognized surgical correction can lead to a good prognosis.